Provider Demographics
NPI:1275210569
Name:GHISALBERTI, PIERANGELO ANTONIO (DDS)
Entity Type:Individual
Prefix:
First Name:PIERANGELO
Middle Name:ANTONIO
Last Name:GHISALBERTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7918 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4120
Mailing Address - Country:US
Mailing Address - Phone:201-854-1616
Mailing Address - Fax:201-854-1434
Practice Address - Street 1:7918 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4120
Practice Address - Country:US
Practice Address - Phone:201-854-1616
Practice Address - Fax:201-854-1434
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029860001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice