Provider Demographics
NPI:1154845659
Name:PERELLA, JOSEPH SEBASTIAN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SEBASTIAN
Last Name:PERELLA
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 OAKWOOD VLG APT 8
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-8907
Mailing Address - Country:US
Mailing Address - Phone:856-305-6859
Mailing Address - Fax:
Practice Address - Street 1:1104 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7901
Practice Address - Country:US
Practice Address - Phone:610-437-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0414781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice