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General NPI Number Information
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NPI Number | 1811173560
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Entity Type | Individual
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Provider Name | RICARDO PERALES D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 25 HOMESTEAD RD N STE 15
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-6600
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Country | US
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Telephone | 239-368-4997
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Fax | 239-368-4996
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Provider Business Mailing Address
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Address Line | 10730 NW 66TH ST APT A-110
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City | DORAL
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State | FL
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Zip | 33178-3706
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Country | US
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Telephone | 305-674-9324
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Fax |
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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 | DN 15473
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License Number State | FL
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