Provider Demographics
NPI:1538545652
Name:SERRATELLI, PETER JR (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:SERRATELLI
Suffix:JR
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 1:22 HOWARD BLVD
Mailing Address - Street 2:104
Mailing Address - City:MOUNT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-1532
Mailing Address - Country:US
Mailing Address - Phone:973-770-3322
Mailing Address - Fax:973-770-3772
Practice Address - Street 1:22 HOWARD BLVD
Practice Address - Street 2:104
Practice Address - City:MOUNT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-1532
Practice Address - Country:US
Practice Address - Phone:973-770-3322
Practice Address - Fax:973-770-3772
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026120001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice