Provider Demographics
NPI:1053989939
Name:PIEROTTI, JUSTIN (DMD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:PIEROTTI
Suffix:
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 1:114 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILMAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08340-3039
Mailing Address - Country:US
Mailing Address - Phone:609-774-8183
Mailing Address - Fax:
Practice Address - Street 1:556 N HARDING HWY
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8713
Practice Address - Country:US
Practice Address - Phone:856-697-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028435001223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health