MEDICARE: PEREZ AND STREETER DENTAL CORPORATION

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	14883	CA

General Provider Information

NPI Number	:	1316077977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEREZ AND STREETER DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	3701 STOCKER ST
Second Line	:	SUITE # 405
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-5108
Country	:	US
Telephone Number	:	323-291-1024
Fax Number	:	323-291-2044

Provider Business Practice Location Address
First Line	:	3701 STOCKER ST
Second Line	:	SUITE # 405
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-5108
Country	:	US
Telephone Number	:	323-291-1024
Fax Number	:	323-291-2044

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELWOOD J. STREETER
Credential	:	D.D.S.
Telephone Number	:	323-291-1024

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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