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NPI Code Detail

MEDICARE: DR. JACK PIERMATTI D.M.D.

MEDICARE: DR. JACK PIERMATTI D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0700XProsthodonticsDN20964FL
21223P0700XProsthodontics12118NJ

General Provider Information

NPI Number : 1437122025
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK PIERMATTI D.M.D.
Provider Business Mailing Address
First Line : 8660 LAKESIDE BND STE C1
Second Line :
City : PARKLAND
State : FL
Zip : 33076-2884
Country : US
Telephone Number : 609-314-1649
Fax Number :
Provider Business Practice Location Address
First Line : 3301 COLLEGE AVE
Second Line :
City : DAVIE
State : FL
Zip : 33314-7796
Country : US
Telephone Number : 609-314-1649
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 06/30/2021

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