Healthcare Provider Details

I. General information

NPI: 1801720487
Provider Name (Legal Business Name): ALEXIS PISCITELLO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 NW ALBRITTON LN
LAKE CITY FL
32055-4451
US

IV. Provider business mailing address

23476 NW 186TH AVE
HIGH SPRINGS FL
32643-0673
US

V. Phone/Fax

Practice location:
  • Phone: 386-752-5904
  • Fax: 352-463-6271
Mailing address:
  • Phone: 386-454-0698
  • Fax: 386-454-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: