Provider Demographics
NPI:1164697108
Name:JOEY D PESICEK
Entity Type:Organization
Organization Name:JOEY D PESICEK
Other - Org Name:KINSTON DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PESICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-523-4151
Mailing Address - Street 1:1104 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-3616
Mailing Address - Country:US
Mailing Address - Phone:252-523-4151
Mailing Address - Fax:252-527-0738
Practice Address - Street 1:1104 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-3616
Practice Address - Country:US
Practice Address - Phone:252-523-4151
Practice Address - Fax:252-527-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC902V7OtherBLUE CROSS AND BLUE SHIELD