=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578609087
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISAAC VICTOR PERLE DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 05/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1608 ROUTE 88 SUITE 205
-----------------------------------------------------
City | BRICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08724-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-840-4444
-----------------------------------------------------
Fax | 617-738-6940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1608 ROUTE 88 STE 205
-----------------------------------------------------
City | BRICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08724-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 328-404-4447
-----------------------------------------------------
Fax | 848-232-1242
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 14338
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS041716
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 22DI02588100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------