Provider Demographics
NPI:1053965400
Name:PEREZ RIZO, GEISA (DMD)
Entity type:Individual
Prefix:DR
First Name:GEISA
Middle Name:
Last Name:PEREZ RIZO
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 1:4315 S KIRKWOOD RD APT 129
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1240
Mailing Address - Country:US
Mailing Address - Phone:786-716-1493
Mailing Address - Fax:
Practice Address - Street 1:5626 E SAM HOUSTON PKWY N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3249
Practice Address - Country:US
Practice Address - Phone:281-452-7900
Practice Address - Fax:833-790-4669
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX355071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice