MEDICARE: PERETZ JOBLOVE PERETZ DDS PA

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	DN10594	FL

General Provider Information

NPI Number	:	1578949426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERETZ JOBLOVE PERETZ DDS PA

Provider Business Mailing Address
First Line	:	4801 HOLLYWOOD BLVD
Second Line	:	SUITE A
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6545
Country	:	US
Telephone Number	:	954-981-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 HOLLYWOOD BLVD
Second Line	:	SUITE A
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6545
Country	:	US
Telephone Number	:	954-981-4500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID ALAN PERETZ
Credential	:	DMD
Telephone Number	:	954-981-4500

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	08/03/2015

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