| Periollp | |
|
230 Centre Street Nutley NJ 07110 | |
| (973) 661-2992 | |
| (973) 661-3513 |
| Full Name | Periollp |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 230 Centre Street, Nutley, New Jersey |
| Authorized Official Name and Position | Cortney Stuart (OFFICE MANAGER) |
| Authorized Official Contact | 9736612992 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periollp 230 Centre Street Nutley NJ 07110 Ph: (973) 661-2992 | Periollp 230 Centre Street Nutley NJ 07110 Ph: (973) 661-2992 |
| NPI Number | 1346541885 |
|---|---|
| Provider Enumeration Date | 11/16/2010 |
| Last Update Date | 11/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346541885 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | DI 20033 (New Jersey) | Secondary |
| 1223P0300X | Dentist - Periodontics | DI18768 (New Jersey) | Primary |
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