Provider Demographics
NPI:1669082160
Name:PEREZ, NICOLE ASHLEY (DMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ASHLEY
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 TAMIAMI TRL E
Mailing Address - Street 2:STE A
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-3433
Mailing Address - Country:US
Mailing Address - Phone:239-799-7244
Mailing Address - Fax:
Practice Address - Street 1:5040 TAMIAMI TRAIL E
Practice Address - Street 2:STE A
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-1483
Practice Address - Country:US
Practice Address - Phone:239-799-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-09
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist