Provider Demographics
NPI:1508097817
Name:PEREZ, DANIEL ENRIQUE (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ENRIQUE
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 KEAGY RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1152
Mailing Address - Country:US
Mailing Address - Phone:540-989-5257
Mailing Address - Fax:
Practice Address - Street 1:3580 KEAGY RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1152
Practice Address - Country:US
Practice Address - Phone:540-989-5257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-248951223S0112X
VA04014193431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204989206Medicaid