Provider Demographics
NPI:1386729739
Name:PERET, SORINA (DDS)
Entity type:Individual
Prefix:
First Name:SORINA
Middle Name:
Last Name:PERET
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 1:28501 RYAN RD
Mailing Address - Street 2:STE D
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092
Mailing Address - Country:US
Mailing Address - Phone:586-753-7000
Mailing Address - Fax:586-753-9926
Practice Address - Street 1:28501 RYAN RD
Practice Address - Street 2:STE D
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092
Practice Address - Country:US
Practice Address - Phone:586-753-7000
Practice Address - Fax:586-753-9926
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI981088OtherUNITED CONCORDIA
MI3525987Medicaid