Provider Demographics
NPI:1578609087
Name:PERLE, ISAAC VICTOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:VICTOR
Last Name:PERLE
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 1:1608 ROUTE 88 STE 205
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3009
Mailing Address - Country:US
Mailing Address - Phone:328-404-4447
Mailing Address - Fax:848-232-1242
Practice Address - Street 1:1608 ROUTE 88
Practice Address - Street 2:SUITE 205
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3009
Practice Address - Country:US
Practice Address - Phone:732-840-4444
Practice Address - Fax:617-738-6940
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14338122300000X
PADS041716122300000X
NJ22DI02588100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0255351Medicaid