MEDICARE: DR. JESSICA MARIE PIZANO DMD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	30.025010	OH
2	1223P0221X	Pediatric Dentistry	DS039571	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235471822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA MARIE PIZANO DMD, MS

Provider Business Mailing Address
First Line	:	126 SENECA DR
Second Line	:
City	:	OLD FORGE
State	:	PA
Zip	:	18518-1598
Country	:	US
Telephone Number	:	570-885-9531
Fax Number	:

Provider Business Practice Location Address
First Line	:	3784 YALICK PLZ UNIT 1
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-7719
Country	:	US
Telephone Number	:	570-456-5566
Fax Number	:	570-456-5567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	10/28/2023

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