Provider Demographics
NPI:1104817766
Name:PEREZ, PEDRO JR (DDS)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:
Last Name:PEREZ
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PEDRO
Other - Middle Name:MORALES
Other - Last Name:PEREZ
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:671 SKYDALE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4241
Mailing Address - Country:US
Mailing Address - Phone:915-581-2030
Mailing Address - Fax:
Practice Address - Street 1:700 S OCHOA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-2936
Practice Address - Country:US
Practice Address - Phone:915-545-7225
Practice Address - Fax:915-533-4878
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18562OtherDENTAL LICENSE