Organization
PERIOLLP
Active
Other names
Advanced Periodontics
Organization subpart
No
Provider details
NPI number
Authorized official
CORTNEY STUART (OFFICE MANAGER)
(973) 661-2992
Entity
Organization
Contact information
Practice address
230 CENTRE STREET, NUTLEY, NJ 07110
(973) 661-2992
(973) 661-3513
Mailing address
230 CENTRE STREET, NUTLEY, NJ 07110
(973) 661-2992
(973) 661-3513
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
DI 20033
NJ
1223P0300X
Periodontics
Primary
DI18768
NJ
Other
Enumeration date
11/16/2010
Last updated
11/16/2010
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