Provider Demographics
NPI:1346220399
Name:WISNIAKOWSKI, KIRSTEN ANN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ANN
Last Name:WISNIAKOWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:KIRSTEN
Other - Middle Name:ANN
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:760 EAST AVE
Mailing Address - Street 2:BLDG 3911
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-5136
Mailing Address - Country:US
Mailing Address - Phone:850-452-8970
Mailing Address - Fax:
Practice Address - Street 1:760 EAST AVE
Practice Address - Street 2:BLDG 3911
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-5136
Practice Address - Country:US
Practice Address - Phone:850-452-8970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist