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General NPI Number Information
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NPI Number | 1578780425
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Entity Type | Individual
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Provider Name | RAFAEL ANTONIO PEREZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2301 MIDWESTERN PKWY STE. #110
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2344
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Country | US
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Telephone | 940-692-2851
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Fax | 940-691-1520
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Provider Business Mailing Address
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Address Line | 2301 MIDWESTERN PKWY STE. #110
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2344
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Country | US
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Telephone | 940-692-2851
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Fax | 940-691-1520
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 18968
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License Number State | TX
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