MEDICARE: DR. RICARDO PERALES D.M.D.

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	DN 15473	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811173560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICARDO PERALES D.M.D.

Provider Business Mailing Address
First Line	:	10730 NW 66TH ST APT A-110
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-3706
Country	:	US
Telephone Number	:	305-674-9324
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 HOMESTEAD RD N STE 15
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-6600
Country	:	US
Telephone Number	:	239-368-4997
Fax Number	:	239-368-4996

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

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/11/2008

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