Provider Demographics
NPI:1073681060
Name:GREGORY VANVLIETDDS,PETER PERERA DMD,PA
Entity Type:Organization
Organization Name:GREGORY VANVLIETDDS,PETER PERERA DMD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANVLIET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-427-0300
Mailing Address - Street 1:33 SICOMAC RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2971
Mailing Address - Country:US
Mailing Address - Phone:973-427-0300
Mailing Address - Fax:973-427-7745
Practice Address - Street 1:33 SICOMAC RD
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2971
Practice Address - Country:US
Practice Address - Phone:973-427-0300
Practice Address - Fax:973-427-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI012710001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty