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NPI Code Detail

MEDICARE: DR. ANDREA ERIKA PEREZ D.D.S.

MEDICARE:  DR. ANDREA ERIKA PEREZ  D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1073740361
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREA ERIKA PEREZ D.D.S.
Provider Business Mailing Address
First Line : 2 HOLLYWOOD LN
Second Line :
City : MASSAPEQUA PARK
State : NY
Zip : 11762-1911
Country : US
Telephone Number : 516-557-9023
Fax Number :
Provider Business Practice Location Address
First Line : 2 HOLLYWOOD LN
Second Line :
City : MASSAPEQUA PARK
State : NY
Zip : 11762-1911
Country : US
Telephone Number : 516-557-9023
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2009
Last Update Date : 06/15/2009

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