MEDICARE: DR. RAUL 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
1	1223P0221X	Pediatric Dentistry	DN 11861	FL

General Provider Information

NPI Number	:	1316935810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAUL PEREZ D.D.S.

Provider Business Mailing Address
First Line	:	2771 MONUMENT RD
Second Line	:	SUITE #23
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-5549
Country	:	US
Telephone Number	:	904-645-9555
Fax Number	:	904-641-5291

Provider Business Practice Location Address
First Line	:	2771 MONUMENT RD
Second Line	:	SUITE #23
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-5549
Country	:	US
Telephone Number	:	904-645-9555
Fax Number	:	904-641-5291

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/08/2007

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