Provider Demographics
NPI:1033264460
Name:DUDA, PETER W
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:W
Last Name:DUDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-2002
Mailing Address - Country:US
Mailing Address - Phone:973-371-9633
Mailing Address - Fax:
Practice Address - Street 1:264 BOYDEN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3070
Practice Address - Country:US
Practice Address - Phone:973-761-4910
Practice Address - Fax:973-761-8748
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO177981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice