Provider Demographics
NPI:1770336729
Name:PISSANI, MIGUEL ANGELO (DDS)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGELO
Last Name:PISSANI
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 1:1203 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-2210
Mailing Address - Country:US
Mailing Address - Phone:650-274-3683
Mailing Address - Fax:
Practice Address - Street 1:222 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1722
Practice Address - Country:US
Practice Address - Phone:650-299-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist