Provider Demographics
NPI:1962578138
Name:PISANO, JEROME VICTOR (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:VICTOR
Last Name:PISANO
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1701 E WOODFIELD RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5905
Mailing Address - Country:US
Mailing Address - Phone:847-605-8880
Mailing Address - Fax:847-605-8901
Practice Address - Street 1:1701 E WOODFIELD RD
Practice Address - Street 2:SUITE 520
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5905
Practice Address - Country:US
Practice Address - Phone:847-605-8880
Practice Address - Fax:847-605-8901
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics