Provider Demographics
NPI:1528797776
Name:PEREIRA, ANGELO (DMD)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:PEREIRA
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 1:35384 EASTBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-8400
Mailing Address - Country:US
Mailing Address - Phone:727-657-6965
Mailing Address - Fax:
Practice Address - Street 1:1421 BARTOW RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6574
Practice Address - Country:US
Practice Address - Phone:855-552-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0007033-C1122300000X
FLDN27724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist