Provider Demographics
NPI:1437614021
Name:LOERA, PERLA A (DDS)
Entity type:Individual
Prefix:DR
First Name:PERLA
Middle Name:A
Last Name:LOERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 GEORGE DIETER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3963
Mailing Address - Country:US
Mailing Address - Phone:915-996-9866
Mailing Address - Fax:
Practice Address - Street 1:HERMANOS ESCOBAR 2703-1
Practice Address - Street 2:
Practice Address - City:CIUDAD JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32300
Practice Address - Country:MX
Practice Address - Phone:915-996-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30910601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3091060OtherUNITED HEALTH CARE DUAL COMPLETE