Provider Demographics
NPI:1518608959
Name:GIANCASPRO, JESSICA ELIZABETH (RDH)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:GIANCASPRO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 57TH ST APT 34J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1095
Mailing Address - Country:US
Mailing Address - Phone:631-357-0724
Mailing Address - Fax:
Practice Address - Street 1:247 3RD AVE RM 202
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7453
Practice Address - Country:US
Practice Address - Phone:212-641-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027880124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY824131623OtherRDH