Provider Demographics
NPI:1801167135
Name:DI PIAZZA, JACQUELINE FRATTO (DMD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:FRATTO
Last Name:DI PIAZZA
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 1:326 FOREST GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3748
Mailing Address - Country:US
Mailing Address - Phone:412-331-2533
Mailing Address - Fax:412-331-9878
Practice Address - Street 1:326 FOREST GROVE RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-3748
Practice Address - Country:US
Practice Address - Phone:412-331-2533
Practice Address - Fax:412-331-9878
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028841L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice