MEDICARE: ANGELO PEREIRA DMD

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	122300000X	Dentist	D-0007033-C1	AL
2	122300000X	Dentist	DN27724	FL

General Provider Information

NPI Number	:	1528797776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELO PEREIRA DMD

Provider Business Mailing Address
First Line	:	35384 EASTBROOK AVE
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33541-8400
Country	:	US
Telephone Number	:	727-657-6965
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 BARTOW RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-6574
Country	:	US
Telephone Number	:	855-552-5355
Fax Number	:

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

Provider Enumeration Date	:	06/05/2022
Last Update Date	:	08/31/2023

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