1760903678 NPI number — RAUL D PEREZ DDS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760903678 NPI number — RAUL D PEREZ DDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAUL D PEREZ DDS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WHITECREST - SMART DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760903678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1163 W GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVER BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93433-2149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-904-6979
Provider Business Mailing Address Fax Number:
805-904-6989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1163 W GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVER BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93433-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-904-6979
Provider Business Practice Location Address Fax Number:
805-904-6979
Provider Enumeration Date:
06/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
RAUL
Authorized Official Middle Name:
DARIO
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
805-904-6979

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  61046 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com