Individual
DR. JUSTIN PISANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
429 NW 11TH ST, APT 6, OKLAHOMA CITY, OK 73103-3927
(734) 604-1843
Mailing address
1942 SHERMAN ST SE, GRAND RAPIDS, MI 49506-2918
(734) 604-1843
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
1318
OK
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901022858
MI
Other
Enumeration date
11/19/2015
Last updated
12/08/2021
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