Provider Demographics
NPI:1497896765
Name:PESICEK, STEPHEN SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SCOTT
Last Name:PESICEK
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 1:6 CEREMONIAL CLOSE
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-6905
Mailing Address - Country:US
Mailing Address - Phone:330-262-4448
Mailing Address - Fax:
Practice Address - Street 1:567 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-3400
Practice Address - Country:US
Practice Address - Phone:330-262-0206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH196101223G0001X
SC39361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice