Provider Demographics
NPI:1114814068
Name:PETTISANI, ALEXIS MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:MARIE
Last Name:PETTISANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-1443
Mailing Address - Country:US
Mailing Address - Phone:856-685-9274
Mailing Address - Fax:
Practice Address - Street 1:1500 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-6610
Practice Address - Country:US
Practice Address - Phone:856-691-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI031009001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice