Individual
DR. JUAN ALBERTO PERALTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3730 103RD ST, SUITE C1, CORONA, NY 11368-1900
(718) 426-0820
Mailing address
3730 103RD ST, SUITE C1, CORONA, NY 11368-1900
(718) 426-0820
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
041315-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01125795
—
NY
Enumeration date
11/30/2006
Last updated
07/09/2007
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