Provider Demographics
NPI:1811619299
Name:NISNISAN, MARY JOCELYN ELYSE M (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY JOCELYN ELYSE
Middle Name:M
Last Name:NISNISAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 THISTLEROCK LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8829
Mailing Address - Country:US
Mailing Address - Phone:832-651-3240
Mailing Address - Fax:
Practice Address - Street 1:3415 FM 762 RD STE 150
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5507
Practice Address - Country:US
Practice Address - Phone:832-431-4316
Practice Address - Fax:832-476-0600
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX389841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice