Provider Demographics
NPI:1841671096
Name:PISOTTI, GREGORY D
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:PISOTTI
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 1:8000 CARMEL AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2973
Mailing Address - Country:US
Mailing Address - Phone:505-883-0323
Mailing Address - Fax:505-884-5471
Practice Address - Street 1:8000 CARMEL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2973
Practice Address - Country:US
Practice Address - Phone:505-883-0323
Practice Address - Fax:505-884-5471
Is Sole Proprietor?:No
Enumeration Date:2015-06-13
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist