Provider Demographics
NPI:1285978783
Name:PISTO, NICK F (DDS)
Entity type:Individual
Prefix:DR
First Name:NICK
Middle Name:F
Last Name:PISTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 N EOLA RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9409
Mailing Address - Country:US
Mailing Address - Phone:630-236-1990
Mailing Address - Fax:630-236-1987
Practice Address - Street 1:1242 N EOLA RD
Practice Address - Street 2:SUITE D
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9409
Practice Address - Country:US
Practice Address - Phone:630-236-1990
Practice Address - Fax:630-236-1987
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0230331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice