Provider Demographics
NPI:1285131771
Name:PEREZ ENEZ, NINOSKA DEL VALLE (DDS)
Entity type:Individual
Prefix:
First Name:NINOSKA
Middle Name:DEL VALLE
Last Name:PEREZ ENEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 NE 30TH ST APT 1606
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4337
Mailing Address - Country:US
Mailing Address - Phone:954-857-1739
Mailing Address - Fax:
Practice Address - Street 1:480 NE 30TH ST APT 1606
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4337
Practice Address - Country:US
Practice Address - Phone:954-857-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL252321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program