Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jorge Emilio Peralta Gonzalez, DMD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1649021296

Jorge Emilio Peralta Gonzalez, DMD is a Student in an Organized Health Care Education/Training Program in Roxbury, Massachusetts. Licensed in Massachusetts. Registered with an NPI since 2024.

Licensed in
MA
In the registry since
2024
Specialties on file
2
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

16 Taber St Unit 304
Roxbury, MA 02119-4231
Phone: (914) 572-1195
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence DN10000576 (MA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1649021296
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD
Sole proprietorNo
NPI enumeratedApril 1, 2024
Last updated in NPPESFebruary 25, 2025
Certification dateFebruary 25, 2025

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