MEDICARE: DR. LETICIA F. PEREZOUS DDS, MS

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	1223P0700X	Prosthodontics	21887	TX

General Provider Information

NPI Number	:	1457470536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LETICIA F. PEREZOUS DDS, MS

Provider Business Mailing Address
First Line	:	1310 VILLAGE GARDEN DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-1513
Country	:	US
Telephone Number	:	281-499-7182
Fax Number	:

Provider Business Practice Location Address
First Line	:	7676 WOODWAY DR STE 310
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-1523
Country	:	US
Telephone Number	:	713-781-4100
Fax Number	:	713-781-7877

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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