Provider Demographics
NPI:1336732692
Name:PIERPOLINE, JONATHAN DAVID
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:PIERPOLINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BOULEVARD
Mailing Address - Street 2:6.146 JOHN SEALY ANNEX
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BOULEVARD
Practice Address - Street 2:6.146 JOHN SEALY ANNEX
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0527
Practice Address - Country:US
Practice Address - Phone:832-221-7507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38273122300000X
MI2901600871122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program