Provider Demographics
NPI:1316077977
Name:PEREZ AND STREETER DENTAL CORPORATION
Entity type:Organization
Organization Name:PEREZ AND STREETER DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELWOOD
Authorized Official - Middle Name:J
Authorized Official - Last Name:STREETER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-291-1024
Mailing Address - Street 1:3701 STOCKER ST
Mailing Address - Street 2:SUITE # 405
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5108
Mailing Address - Country:US
Mailing Address - Phone:323-291-1024
Mailing Address - Fax:323-291-2044
Practice Address - Street 1:3701 STOCKER ST
Practice Address - Street 2:SUITE # 405
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5108
Practice Address - Country:US
Practice Address - Phone:323-291-1024
Practice Address - Fax:323-291-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty