Provider Demographics
NPI:1225058142
Name:PESTANO, CECILE DECLARO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CECILE
Middle Name:DECLARO
Last Name:PESTANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CECILE
Other - Middle Name:C
Other - Last Name:DECLARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:32 TIMBER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5515
Mailing Address - Country:US
Mailing Address - Phone:609-468-7197
Mailing Address - Fax:501-423-4510
Practice Address - Street 1:57 W 58TH ST
Practice Address - Street 2:SUITE 1, 2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1630
Practice Address - Country:US
Practice Address - Phone:212-593-3822
Practice Address - Fax:501-423-4510
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0483981223G0001X
NJ22DI021447001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY908363OtherUNITED CONCORDIA PROVIDER