Periodontics and Implant Dentistry, PA

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DI10755 Issued in NJ

Legal business name

PERIODONTICS AND IMPLANT DENTISTRY, PA

Practice address

160 S Livingston Ave
Suite110-111
Livingston, NJ 07039-3033

Phone

(973) 994-9995

Fax

(973) 994-1991

NPI assigned

Nov 17, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Barry David Wagenberg, DMDNPI 1699849240

Title

President

Phone

(973) 994-9995

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Barry David Wagenberg, DMD

  • Periodontics
  • Livingston, NJ
  • NPI 1699849240
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376617902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 S LIVINGSTON AVE",
            "address_2": "SUITE110-111",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070393033",
            "telephone_number": "973-994-9995",
            "fax_number": "973-994-1991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 S LIVINGSTON AVE",
            "address_2": "SUITE110-111",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070393033",
            "telephone_number": "973-994-9995",
            "fax_number": "973-994-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTICS AND IMPLANT DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAGENBERG",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-994-9995",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "NJ",
            "license": "DI10755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Maria Pelaez, M.D.
• Martin Pena Jr., LSW
• Madhavi Pentyala, M.D.
• Jennifer Renee Peos, MD
• Periodontic and Oral Medicine
• John Perkoff, PHYSICIAN ASSISTANT
• Lisa Carol Perline, LCSW
• Barry Perlman, DO
• Adam Perna, LAC
• David John Perna, M.D.

• Periodontics in Livingston, NJ
• Providers in Livingston, NJ by specialty
• Periodontics in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.