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Organization
PERIODONTAL CONSULTANTS, PA
Active
Organization
PERIODONTAL CONSULTANTS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAELA AGOSTO (DIRECTOR)
(267) 334-0082
Entity
Organization
Contact information
Practice address
1910 EAST MARLTON PIKE, THE ATRIUM SUITE #2, CHERRY HILL, NJ 08003
(856) 428-4746
(856) 751-3975
Mailing address
1910 EAST MARLTON PIKE, THE ATRIUM SUITE #2, CHERRY HILL, NJ 08003
(856) 428-4746
(856) 751-3975
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101051655
BUSINESS IDENTIFICATION NUMBER
NJ
Enumeration date
08/07/2019
Last updated
08/07/2019
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