Provider Demographics
NPI:1629293881
Name:PERETTA, FRANK MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:MICHAEL
Last Name:PERETTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:666 LEXINGTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3632
Mailing Address - Country:US
Mailing Address - Phone:914-241-1556
Mailing Address - Fax:914-241-1382
Practice Address - Street 1:666 LEXINGTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3632
Practice Address - Country:US
Practice Address - Phone:914-241-1556
Practice Address - Fax:914-241-1382
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0302141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030214OtherDENTAL LIC #
AP6630289OtherUS DEA #
AP6630289OtherUS DEA #