Provider Demographics
NPI:1437217783
Name:GUADALUPE L PEREIRA DMD APC
Entity type:Organization
Organization Name:GUADALUPE L PEREIRA DMD APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:CARRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-715-6135
Mailing Address - Street 1:144 W. CARSON ST., CARSON, CA 90745
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:310-847-7777
Mailing Address - Fax:310-835-0199
Practice Address - Street 1:144 W CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2601
Practice Address - Country:US
Practice Address - Phone:310-847-7777
Practice Address - Fax:310-835-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty