Provider Demographics
NPI:1982816393
Name:PERRICCI, JEFFREY M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:PERRICCI
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 1:42 RICHARD DR
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1504
Mailing Address - Country:US
Mailing Address - Phone:201-991-1733
Mailing Address - Fax:201-991-3199
Practice Address - Street 1:594 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2812
Practice Address - Country:US
Practice Address - Phone:201-991-1733
Practice Address - Fax:201-991-3199
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ179391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice