Provider Demographics
NPI:1912074980
Name:JEROME V. PISANO, D.D.S.,M.S.,P.C.
Entity Type:Organization
Organization Name:JEROME V. PISANO, D.D.S.,M.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:PISANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:847-605-8880
Mailing Address - Street 1:1701 E WOODFIELD RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5905
Mailing Address - Country:US
Mailing Address - Phone:847-605-8880
Mailing Address - Fax:847-605-8901
Practice Address - Street 1:1701 E WOODFIELD RD
Practice Address - Street 2:SUITE 520
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5905
Practice Address - Country:US
Practice Address - Phone:847-605-8880
Practice Address - Fax:847-605-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty