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General NPI Number Information
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NPI Number | 1982761573
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Entity Type | Organization
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Legal Business Name | PEREZ DENTAL CORP
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 125 E GLENOAKS BLVD SUITE 103
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City | GLENDALE
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State | CA
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Zip | 91207
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Country | US
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Telephone | 818-246-3736
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Fax | 818-246-9436
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Provider Business Mailing Address
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Address Line | 125 E GLENOAKS BLVD SUITE 103
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City | GLENDALE
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State | CA
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Zip | 91207
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Country | US
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Telephone | 818-246-3736
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Fax | 818-246-9436
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AZATUI AKOPYAN
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Credential |
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Telephone | 818-246-3736
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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 | 39063
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License Number State |
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