Provider Demographics
NPI:1558488684
Name:PEDUTO, PAUL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:PEDUTO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2373
Mailing Address - Country:US
Mailing Address - Phone:732-842-2337
Mailing Address - Fax:732-842-7703
Practice Address - Street 1:302 RIVER RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2373
Practice Address - Country:US
Practice Address - Phone:732-842-2337
Practice Address - Fax:732-842-7703
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009277001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice