=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235471822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA MARIE PIZANO DMD, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2013
-----------------------------------------------------
Last Update Date | 10/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3784 YALICK PLZ UNIT 1
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18612-7719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-456-5566
-----------------------------------------------------
Fax | 570-456-5567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 SENECA DR
-----------------------------------------------------
City | OLD FORGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18518-1598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-885-9531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 30.025010
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DS039571
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------