Provider Demographics
NPI:1982267324
Name:PERRO, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:PERRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JOHN SINGER SARGENT WAY
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-7214
Mailing Address - Country:US
Mailing Address - Phone:609-405-2539
Mailing Address - Fax:
Practice Address - Street 1:1630 ROUTE 322
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-3701
Practice Address - Country:US
Practice Address - Phone:856-832-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027871001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice