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General NPI Number Information
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NPI Number | 1801001276
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Entity Type | Individual
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Provider Name | ERNESTO JUAN PEREZ DMD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CARR 891 KM 15.1 BO.PUEBLO
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City | COROZAL
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State | PR
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Zip | 00783
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Country | US
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Telephone | 787-859-0035
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Fax | 787-859-0070
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Provider Business Mailing Address
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Address Line | HC-01 BOX. 3021 BO. PUEBLO
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City | COROZAL
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State | PR
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Zip | 00783
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Country | US
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Telephone | 787-859-0035
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Fax | 787-859-0070
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 1923
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License Number State | PR
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