Provider Demographics
NPI:1699337253
Name:GARCIA PEREZ, EDUARDO ENRIQUE (DMD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ENRIQUE
Last Name:GARCIA 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 1:3639 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4214
Mailing Address - Country:US
Mailing Address - Phone:786-277-3353
Mailing Address - Fax:
Practice Address - Street 1:17868 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2806
Practice Address - Country:US
Practice Address - Phone:954-538-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN244021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice