Individual
DR. CECILE DECLARO PESTANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
57 W 58TH ST, SUITE 1, 2ND FLOOR, NEW YORK, NY 10019-1630
(212) 593-3822
(501) 423-4510
Mailing address
32 TIMBER RIDGE RD, NORTH BRUNSWICK, NJ 08902-5515
(609) 468-7197
(501) 423-4510
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
048398
NY
1223G0001X
General Practice Dentistry
22DI02144700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
908363
UNITED CONCORDIA PROVIDER
NY
Enumeration date
07/21/2006
Last updated
07/08/2007
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