Provider Demographics
NPI:1366542821
Name:FERNANDEZ PEREYO, JOSE L (DMD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:FERNANDEZ PEREYO
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:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0427
Mailing Address - Country:US
Mailing Address - Phone:787-850-3450
Mailing Address - Fax:787-850-3450
Practice Address - Street 1:CALLE DOCTOR VIDAL
Practice Address - Street 2:ESQUINA ANTONIO LOPEZ
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-850-3450
Practice Address - Fax:787-850-3450
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14581223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics