Provider Demographics
NPI:1790483857
Name:KWASNIK, CORIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORIN
Middle Name:
Last Name:KWASNIK
Suffix:
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 1:433 THERRIAULT HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:VT
Mailing Address - Zip Code:05679-9683
Mailing Address - Country:US
Mailing Address - Phone:802-272-6124
Mailing Address - Fax:
Practice Address - Street 1:395 PAINE TPKE N
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9157
Practice Address - Country:US
Practice Address - Phone:802-272-6124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01601341921223G0001X
VT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program