Provider Demographics
NPI:1144202110
Name:MATOS-PERROTTE, VIRGINIA (DMD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:MATOS-PERROTTE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854
Mailing Address - Country:US
Mailing Address - Phone:732-369-3764
Mailing Address - Fax:
Practice Address - Street 1:277 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1311
Practice Address - Country:US
Practice Address - Phone:732-235-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO1497200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ003469Medicaid