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General NPI Number Information
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NPI Number | 1386423358
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Entity Type | Individual
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Provider Name | RAFFAELE PISANO UHRI DDS
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Gender | Male
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 3116 MOUNT VERNON AVE # 100
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City | ALEXANDRIA
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State | VA
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Zip | 22305-2639
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Country | US
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Telephone | 703-584-5416
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Fax |
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Provider Business Mailing Address
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Address Line | 839 NANDINA DR
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City | WESTON
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State | FL
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Zip | 33327-2408
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Country | US
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Telephone | 813-705-5097
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 0401418317
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License Number State | VA
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