MEDICARE: DR. RICHARD PERELLO D.D.S.

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
1	1223G0001X	General Practice Dentistry	13600	NJ

General Provider Information

NPI Number	:	1649284399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD PERELLO D.D.S.

Provider Business Mailing Address
First Line	:	8008 ROUTE 130 NORTH
Second Line	:	SUITE 330
City	:	DELRAN
State	:	NJ
Zip	:	08075
Country	:	US
Telephone Number	:	856-461-0900
Fax Number	:	856-461-6184

Provider Business Practice Location Address
First Line	:	8008 ROUTE 130 NORTH
Second Line	:	SUITE 330
City	:	DELRAN
State	:	NJ
Zip	:	08075-1869
Country	:	US
Telephone Number	:	856-461-0900
Fax Number	:	856-461-6184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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