Provider Demographics
NPI:1316598691
Name:SISO, ELIZABETH KUNCEWICZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KUNCEWICZ
Last Name:SISO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 KIPLING ST APT 842
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1775
Mailing Address - Country:US
Mailing Address - Phone:832-489-1594
Mailing Address - Fax:
Practice Address - Street 1:2000 S DAIRY ASHFORD RD STE 530
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5729
Practice Address - Country:US
Practice Address - Phone:832-489-1594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX357181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice