Provider Demographics
NPI:1417049255
Name:PERERA, PETER (DMD, PA)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:PERERA
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SICOMAC ROAD
Mailing Address - Street 2:SUITE 202
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 ROAD
Practice Address - Street 2:SUITE 202
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
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ183381223G0001X
NJDI0183381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice