Provider Demographics
NPI:1962536714
Name:PEREZ, EDNA (DMD)
Entity type:Individual
Prefix:DR
First Name:EDNA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100426 DEPARTMENT OF PEDIATRIC DENTISTRY
Mailing Address - Street 2:COLLEGE OF DENTISTRY, UNIVERSITY OF FLORIDA
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0426
Mailing Address - Country:US
Mailing Address - Phone:352-273-7631
Mailing Address - Fax:352-273-6765
Practice Address - Street 1:1600 SW ARCHER ROAD DEPARTMENT OF PEDIATRIC DENTISTRY
Practice Address - Street 2:COLLEGE OF DENTISTRY, UNIVERSITY OF FLORIDA
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0426
Practice Address - Country:US
Practice Address - Phone:352-273-7631
Practice Address - Fax:352-273-6765
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN182341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003106100Medicaid