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NPI Code Detail

MEDICARE: DR. PEDRO PEREZ JR. DDS

MEDICARE:  DR. PEDRO  PEREZ 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
1122300000XDentist18562TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
118562OTHERTXDENTAL LICENSE

General Provider Information

NPI Number : 1104817766
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PEDRO PEREZ JR. DDS
Provider Business Mailing Address
First Line : 671 SKYDALE DR
Second Line :
City : EL PASO
State : TX
Zip : 79912-4241
Country : US
Telephone Number : 915-581-2030
Fax Number :
Provider Business Practice Location Address
First Line : 700 S OCHOA ST
Second Line :
City : EL PASO
State : TX
Zip : 79901-2936
Country : US
Telephone Number : 915-545-7225
Fax Number : 915-533-4878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 07/08/2007

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Directions to “ DR. PEDRO PEREZ JR. DDS” Practice Location

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