Provider Demographics
NPI:1467476648
Name:KISH, JOHN GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GERALD
Last Name:KISH
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 1:2642 KUSER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1804
Mailing Address - Country:US
Mailing Address - Phone:609-890-7565
Mailing Address - Fax:609-890-7527
Practice Address - Street 1:2642 KUSER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691-1804
Practice Address - Country:US
Practice Address - Phone:609-890-7525
Practice Address - Fax:609-890-7527
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011885001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice