Provider Demographics
NPI:1265524904
Name:CERTO, PETER CARMEN JR (DMD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:CARMEN
Last Name:CERTO
Suffix:JR
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 1:2940 A CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-2943
Mailing Address - Country:US
Mailing Address - Phone:610-364-1345
Mailing Address - Fax:610-364-1347
Practice Address - Street 1:2940 CONCORD RD
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-2943
Practice Address - Country:US
Practice Address - Phone:610-364-1345
Practice Address - Fax:610-364-1347
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028538L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
450916Medicare UPIN