MEDICARE: LISELOTT PEREZ DDS

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	4308	NV

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	:	1932131406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISELOTT PEREZ DDS

Provider Business Mailing Address
First Line	:	4800 ALPINE PL
Second Line	:	STE 1
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-4084
Country	:	US
Telephone Number	:	702-870-6362
Fax Number	:	702-870-6399

Provider Business Practice Location Address
First Line	:	4800 ALPINE PL
Second Line	:	STE 1
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-4084
Country	:	US
Telephone Number	:	702-870-6362
Fax Number	:	702-870-6399

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	02/14/2013

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