Provider Demographics
NPI:1235471822
Name:PIZANO, JESSICA MARIE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:PIZANO
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1598
Mailing Address - Country:US
Mailing Address - Phone:570-885-9531
Mailing Address - Fax:
Practice Address - Street 1:3784 YALICK PLZ UNIT 1
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-7719
Practice Address - Country:US
Practice Address - Phone:570-456-5566
Practice Address - Fax:570-456-5567
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2023-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0250101223P0221X
PADS0395711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0227239Medicaid