Provider Demographics
NPI:1326056078
Name:PESARCHICK, THOMAS J (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:PESARCHICK
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 1:8307 WINDHAM STREET
Mailing Address - Street 2:UNIVERSITY OF GARRETTSVILLE SKY PLAZA PROFESSIONAL BUIL
Mailing Address - City:GARRETTESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231
Mailing Address - Country:US
Mailing Address - Phone:330-527-3368
Mailing Address - Fax:330-527-3369
Practice Address - Street 1:8307 WINDHAM STREET
Practice Address - Street 2:
Practice Address - City:GARRETTESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231
Practice Address - Country:US
Practice Address - Phone:330-527-3368
Practice Address - Fax:330-527-3369
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2399113Medicaid
OH2399113Medicaid
OHPE311701Medicare PIN
OHU94951Medicare UPIN