Provider Demographics
NPI:1982968020
Name:PIYA, JESBINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESBINA
Middle Name:
Last Name:PIYA
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 1:7 PLEASANT ST
Mailing Address - Street 2:MALDEN FAMILY DENTAL
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5106
Mailing Address - Country:US
Mailing Address - Phone:612-747-9282
Mailing Address - Fax:
Practice Address - Street 1:7 PLEASANT ST
Practice Address - Street 2:MALDEN FAMILY DENTAL
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5106
Practice Address - Country:US
Practice Address - Phone:612-747-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18560291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice