Individual
DR. DANTE PEREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3120
(918) 458-3279
Mailing address
PO BOX 1920, TAHLEQUAH, OK 74465-1920
(918) 458-3120
(918) 458-3279
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
19710
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100220460A
SOONERCARE
OK
05
—
150301001
—
AK
Enumeration date
12/05/2007
Last updated
12/05/2007
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