Provider Demographics
NPI:1629250675
Name:PISTILLI, JEANINE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:MARIE
Last Name:PISTILLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 LAKE AVE S
Mailing Address - Street 2:SUITE A
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1047
Mailing Address - Country:US
Mailing Address - Phone:631-360-7337
Mailing Address - Fax:
Practice Address - Street 1:62 LAKE AVE S
Practice Address - Street 2:SUITE A
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1047
Practice Address - Country:US
Practice Address - Phone:631-360-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-01
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry