Provider Demographics
NPI:1821116310
Name:KASISA, MAGGIE (DDS)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:KASISA
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 1:2C AUER CT.
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-251-6010
Mailing Address - Fax:732-251-6016
Practice Address - Street 1:2C AUER CT.
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-251-6010
Practice Address - Fax:732-251-6016
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022099001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice