Provider Demographics
NPI:1528258779
Name:DIPIETRO, JESSICA DICERBO (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:DICERBO
Last Name:DIPIETRO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:SHANE
Other - Last Name:DICERBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DM D
Mailing Address - Street 1:18947 JOHN J WILLIAMS HWY
Mailing Address - Street 2:SUITE 309
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4474
Mailing Address - Country:US
Mailing Address - Phone:302-644-4460
Mailing Address - Fax:302-644-4470
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY
Practice Address - Street 2:SUITE 309
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971
Practice Address - Country:US
Practice Address - Phone:302-644-4460
Practice Address - Fax:302-644-4470
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00012411223P0221X
PADS0372131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821433145OtherDELTA DENTAL
DE1821433145Medicaid
271596OtherCIGNA
171999OtherGUARDIAN