Provider Demographics
NPI:1710018353
Name:VISNICH, GEORGE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:VISNICH
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2364
Mailing Address - Country:US
Mailing Address - Phone:724-378-9523
Mailing Address - Fax:724-378-7947
Practice Address - Street 1:2501 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2364
Practice Address - Country:US
Practice Address - Phone:724-378-9523
Practice Address - Fax:724-378-7947
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025816-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA17987OtherHEALTH AMERICA HEALTH ASS
PA149847OtherCIGNA
PA25816OtherDELTA DENTAL
PA445108OtherBLUE SHIELD KEYSTONE UNIT
PAT30476Medicare UPIN