Provider Demographics
NPI:1104049832
Name:PERALEZ, JESUS JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:PERALEZ
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 CARRIAGE OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2525
Mailing Address - Country:US
Mailing Address - Phone:210-924-7277
Mailing Address - Fax:210-922-5199
Practice Address - Street 1:600 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-1350
Practice Address - Country:US
Practice Address - Phone:210-924-7277
Practice Address - Fax:210-922-5199
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice