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General NPI Number Information
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NPI Number | 1598733404
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Entity Type | Organization
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Legal Business Name | FRANK J PECORARO DDS PA RICHARD M KELNER DMD PA
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1119 RARITAN RD SUITE 1
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City | CLARK
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State | NJ
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Zip | 07066-1315
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Country | US
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Telephone | 732-382-9090
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Fax | 732-396-1527
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Provider Business Mailing Address
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Address Line | 1119 RARITAN RD SUITE 1
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City | CLARK
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State | NJ
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Zip | 07066-1315
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Country | US
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Telephone | 732-382-9090
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Fax | 732-396-1527
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Authorized Official
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Title or Position | DOCTOR DMD
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Name | DR. RICHARD M KELNER
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Credential | DMD
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Telephone | 732-382-9090
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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 | 22DI00899901
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22DI02152901
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22DI00884501
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License Number State | NJ
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