MEDICARE: RICARDO PERALES DMD 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1952279945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICARDO PERALES DMD PA

Provider Business Mailing Address
First Line	:	25 HOMESTEAD RD N STE 39A
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-6600
Country	:	US
Telephone Number	:	239-368-4997
Fax Number	:	239-368-4996

Provider Business Practice Location Address
First Line	:	25 HOMESTEAD RD N STE 39A
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	:	OWNER
Name	:	RICARDO PERALES
Credential	:
Telephone Number	:	239-368-4997

Provider Enumeration Date	:	10/29/2025
Last Update Date	:	10/29/2025

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