Provider Demographics
NPI:1902964745
Name:PERETZ, DAVID ALAN
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:PERETZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-981-4500
Mailing Address - Fax:954-981-4503
Practice Address - Street 1:4801 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-981-4500
Practice Address - Fax:954-981-4503
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD2215122300000X
FLDN2176122300000X
FLDN10594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist