Provider Demographics
NPI:1932846623
Name:PEREIRA, JOHANA
Entity type:Individual
Prefix:
First Name:JOHANA
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14254 DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:FL
Mailing Address - Zip Code:33527-4414
Mailing Address - Country:US
Mailing Address - Phone:813-653-6100
Mailing Address - Fax:
Practice Address - Street 1:14254 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:FL
Practice Address - Zip Code:33527-4414
Practice Address - Country:US
Practice Address - Phone:813-653-6100
Practice Address - Fax:229-436-4107
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29471122300000X, 1223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program