Provider Demographics
NPI:1003076589
Name:PISANO, DOMINIC (DMD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:
Last Name:PISANO
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 1:70 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2931
Mailing Address - Country:US
Mailing Address - Phone:732-350-7999
Mailing Address - Fax:732-350-7961
Practice Address - Street 1:70 LACEY RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2931
Practice Address - Country:US
Practice Address - Phone:732-350-7999
Practice Address - Fax:732-350-7961
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0094761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice