Healthcare Provider Details

I. General information

NPI: 1760877856
Provider Name (Legal Business Name): KARLA JOSE PEREZ-GOLDBERG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARLA PEREZ DDS

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 MAIN AVE
PASSAIC NJ
07055
US

IV. Provider business mailing address

293 MAIN AVE
PASSAIC NJ
07055
US

V. Phone/Fax

Practice location:
  • Phone: 973-471-0099
  • Fax: 973-396-1840
Mailing address:
  • Phone: 973-471-0099
  • Fax: 973-396-1840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22D102627400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number060264-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number06993
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: