Provider Demographics
NPI:1104594126
Name:PEREZ, DAVID LEON
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEON
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 NEW BRITAIN CIR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-4600
Mailing Address - Country:US
Mailing Address - Phone:831-578-9330
Mailing Address - Fax:
Practice Address - Street 1:126 5TH ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:CA
Practice Address - Zip Code:93926
Practice Address - Country:US
Practice Address - Phone:831-675-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist