Provider Demographics
NPI:1114775731
Name:PEREZ, AMANDA GRACE (DDS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRACE
Last Name:PEREZ
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:GRACE
Other - Last Name:ORZECHOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:18755 SW 212TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-4015
Mailing Address - Country:US
Mailing Address - Phone:786-314-8712
Mailing Address - Fax:
Practice Address - Street 1:1645 E HIGHWAY 50 STE 100
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5199
Practice Address - Country:US
Practice Address - Phone:352-432-1960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice