Provider Demographics
NPI:1154630341
Name:PISANO, CHERYL LYNN (DMD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:PISANO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11223 N WILLIAMS ST STE C
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432
Mailing Address - Country:US
Mailing Address - Phone:352-489-3922
Mailing Address - Fax:352-489-8462
Practice Address - Street 1:11223 N WILLIAMS ST STE C
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-8307
Practice Address - Country:US
Practice Address - Phone:352-489-3922
Practice Address - Fax:352-489-8462
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist