Provider Demographics
NPI:1437517638
Name:PASCUAL, NERISSA DOMINGO
Entity Type:Individual
Prefix:DR
First Name:NERISSA
Middle Name:DOMINGO
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 GOLF PL
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2502
Mailing Address - Country:US
Mailing Address - Phone:201-488-8456
Mailing Address - Fax:201-488-4134
Practice Address - Street 1:360 GOLF PL
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2502
Practice Address - Country:US
Practice Address - Phone:201-488-8456
Practice Address - Fax:201-488-4134
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01867200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist