Individual
JORGE EMILIO PERALTA GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
16 TABER ST UNIT 304, ROXBURY, MA 02119-4231
(914) 572-1195
Mailing address
19 KENILWORTH ST APT 3, ROXBURY, MA 02119-1877
(914) 572-1195
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN10000576
MA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/01/2024
Last updated
02/25/2025
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