Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9929 | NC |
NPI | 1114213790 |
---|---|
Provider Name | Jorge E Perez Santos |
First Address | Raleigh, NC 27615-3546 |
Second Address | Raleigh, NC 27615-3546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 29/09/2015 |