Provider Demographics
NPI:1497818728
Name:PERA, SALVATORE ALBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:ALBERT
Last Name:PERA
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 1:53 GILL RD
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-3401
Mailing Address - Country:US
Mailing Address - Phone:856-616-0211
Mailing Address - Fax:
Practice Address - Street 1:1429 S BROAD ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-4919
Practice Address - Country:US
Practice Address - Phone:215-468-1425
Practice Address - Fax:215-334-9969
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028174-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice