Provider Demographics
NPI:1295186104
Name:WISNIEWSKI, CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:WISNIEWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 GLOVER ST
Mailing Address - Street 2:
Mailing Address - City:GLOVER
Mailing Address - State:VT
Mailing Address - Zip Code:05839-9701
Mailing Address - Country:US
Mailing Address - Phone:800-539-1127
Mailing Address - Fax:844-444-1127
Practice Address - Street 1:3032 GLOVER ST
Practice Address - Street 2:
Practice Address - City:GLOVER
Practice Address - State:VT
Practice Address - Zip Code:05839-9701
Practice Address - Country:US
Practice Address - Phone:800-539-1127
Practice Address - Fax:844-444-1127
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0121171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist