Provider Demographics
NPI:1316354707
Name:PEREZ, ERNESTO RENE (DMD)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:RENE
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3605
Mailing Address - Country:US
Mailing Address - Phone:305-220-9393
Mailing Address - Fax:
Practice Address - Street 1:3201 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3605
Practice Address - Country:US
Practice Address - Phone:305-220-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist