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General NPI Number Information
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NPI Number | 1336494756
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Entity Type | Organization
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Legal Business Name | PECORARO PERIODONTICS
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 445 WATCHUNG AVE
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City | WATCHUNG
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State | NJ
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Zip | 07069-4956
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Country | US
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Telephone | 908-753-4427
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Fax | 908-756-7019
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Provider Business Mailing Address
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Address Line | P.O. BOX 7127
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City | WATCHUNG
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State | NJ
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Zip | 07069-9994
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Country | US
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Telephone | 908-753-4427
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Fax | 908-756-7019
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELISSA LUCILLE PECORARO
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Credential | D.M.D.
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Telephone | 908-753-4427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22DI02152900
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License Number State | NJ
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