MEDICARE: DR. GLORIVI PEREZ 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	1223G0001X	General Practice Dentistry	2293	PR

General Provider Information

NPI Number	:	1821218579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIVI PEREZ D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 20281
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00928-0281
Country	:	US
Telephone Number	:	787-765-7915
Fax Number	:	787-767-5287

Provider Business Practice Location Address
First Line	:	124 CALLE ARZUAGA
Second Line	:
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00925-3302
Country	:	US
Telephone Number	:	787-765-7915
Fax Number	:	787-767-5287

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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