Provider Demographics
NPI:1376502799
Name:PESILLO, CLAYTON ORLANDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:ORLANDO
Last Name:PESILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7065
Mailing Address - Country:US
Mailing Address - Phone:570-524-0022
Mailing Address - Fax:570-742-6397
Practice Address - Street 1:20 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-7909
Practice Address - Country:US
Practice Address - Phone:570-742-9607
Practice Address - Fax:570-742-6397
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS176961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice