MEDICARE: DR. ELISA PEREZ 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	1223P0221X	Pediatric Dentistry	28941	TX

General Provider Information

NPI Number	:	1447682448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISA PEREZ DDS

Provider Business Mailing Address
First Line	:	2134 WINDING VW
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-7238
Country	:	US
Telephone Number	:	210-831-3240
Fax Number	:

Provider Business Practice Location Address
First Line	:	427 SINGING OAKS
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6508
Country	:	US
Telephone Number	:	830-214-7334
Fax Number	:	830-214-7334

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

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	06/11/2024

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