Provider Demographics
NPI:1639286115
Name:PETER R. DUCA, JR., DMD PC
Entity Type:Organization
Organization Name:PETER R. DUCA, JR., DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-953-7400
Mailing Address - Street 1:520 STOKES RD
Mailing Address - Street 2:BUILDING B-18
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2904
Mailing Address - Country:US
Mailing Address - Phone:609-953-7400
Mailing Address - Fax:609-953-4032
Practice Address - Street 1:520 STOKES RD
Practice Address - Street 2:BUILDING B-18
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2904
Practice Address - Country:US
Practice Address - Phone:609-953-7400
Practice Address - Fax:609-953-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017543001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty