Individual
DR. JUAN JOSE PESANTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4104 102ND ST, 2ND FLOOR, CORONA, NY 11368-2480
(718) 651-3939
(718) 651-0159
Mailing address
11109 JAMAICA AVE, RICHMOND HILL, NY 11418-2323
(718) 580-1011
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
046461
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01738614
—
NY
Enumeration date
03/06/2008
Last updated
02/01/2016
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