Provider Demographics
NPI:1528087053
Name:PERRECA, RALPH MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:MICHAEL
Last Name:PERRECA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BOICES LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1005
Mailing Address - Country:US
Mailing Address - Phone:845-336-4440
Mailing Address - Fax:
Practice Address - Street 1:123 BOICES LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1005
Practice Address - Country:US
Practice Address - Phone:845-336-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0328741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics