Provider Demographics
NPI:1265163661
Name:PERERA, LERONNE (DMD)
Entity type:Individual
Prefix:DR
First Name:LERONNE
Middle Name:
Last Name:PERERA
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 1:7950 PARK BLVD N APT 4301
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3765
Mailing Address - Country:US
Mailing Address - Phone:561-755-3657
Mailing Address - Fax:
Practice Address - Street 1:12963 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3538
Practice Address - Country:US
Practice Address - Phone:727-265-3307
Practice Address - Fax:727-233-4977
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist