Provider Demographics
NPI:1780722777
Name:PISANO-MARSH, MICHELE ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ANN
Last Name:PISANO-MARSH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 COLLEGE HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104
Mailing Address - Country:US
Mailing Address - Phone:610-432-8037
Mailing Address - Fax:610-865-1975
Practice Address - Street 1:3055 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-432-8037
Practice Address - Fax:610-865-1975
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026847L1223G0001X
PADS026847-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice