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General NPI Number Information
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NPI Number | 1982267324
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Entity Type | Individual
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Provider Name | RYAN PERRO
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Gender | Male
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 1630 ROUTE 322
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City | SWEDESBORO
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State | NJ
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Zip | 08085-3701
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Country | US
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Telephone | 856-832-4480
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Fax |
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Provider Business Mailing Address
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Address Line | 2 JOHN SINGER SARGENT WAY
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City | MARLTON
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State | NJ
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Zip | 08053-7214
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Country | US
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Telephone | 609-405-2539
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02787100
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License Number State | NJ
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