Provider Demographics
NPI:1336494756
Name:PECORARO PERIODONTICS
Entity Type:Organization
Organization Name:PECORARO PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:PECORARO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-753-4427
Mailing Address - Street 1:P.O. BOX 7127
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-9994
Mailing Address - Country:US
Mailing Address - Phone:908-753-4427
Mailing Address - Fax:908-756-7019
Practice Address - Street 1:445 WATCHUNG AVE
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-4956
Practice Address - Country:US
Practice Address - Phone:908-753-4427
Practice Address - Fax:908-756-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021529001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty