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General NPI Number Information
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NPI Number | 1457508897
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Entity Type | Organization
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Legal Business Name | PERRY M. IACOVETTI DDS PC
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 5231 LITTLE NECK PKWY
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City | LITTLE NECK
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State | NY
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Zip | 11362-1836
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Country | US
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Telephone | 718-224-0040
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Fax |
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Provider Business Mailing Address
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Address Line | 5231 LITTLE NECK PKWY
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City | LITTLE NECK
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State | NY
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Zip | 11362-1836
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Country | US
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Telephone | 718-224-0040
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PERRY M. IACOVETTI
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Credential | D.D.S.
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Telephone | 718-224-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 050882
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License Number State | NY
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