MEDICARE: DR. GERARD STEPHEN PERERA 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
1	1223G0001X	General Practice Dentistry	033971	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164612107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD STEPHEN PERERA D.D.S.

Provider Business Mailing Address
First Line	:	3839 W 1ST ST
Second Line	:	SUITE B-1
City	:	SANTA ANA
State	:	CA
Zip	:	92703-4075
Country	:	US
Telephone Number	:	714-554-5062
Fax Number	:	714-554-5062

Provider Business Practice Location Address
First Line	:	3839 W 1ST ST
Second Line	:	SUITE B-1
City	:	SANTA ANA
State	:	CA
Zip	:	92703-4075
Country	:	US
Telephone Number	:	714-554-5062
Fax Number	:	714-554-5062

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	03/07/2023

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Directions to “ DR. GERARD STEPHEN PERERA D.D.S.” Practice Location

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