MEDICARE: DR. JESUS PERALEZ JR. DDS

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
1	1223G0001X	General Practice Dentistry	20173	TX

General Provider Information

NPI Number	:	1104049832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESUS PERALEZ JR. DDS

Provider Business Mailing Address
First Line	:	7206 CARRIAGE OAKS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2525
Country	:	US
Telephone Number	:	210-924-7277
Fax Number	:	210-922-5199

Provider Business Practice Location Address
First Line	:	600 DIVISION AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-1350
Country	:	US
Telephone Number	:	210-924-7277
Fax Number	:	210-922-5199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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