Provider Demographics
NPI:1942239116
Name:AVISO, VENICE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:VENICE
Middle Name:A
Last Name:AVISO
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 1:66 OAKWYNNE TER
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8525
Mailing Address - Country:US
Mailing Address - Phone:215-279-2850
Mailing Address - Fax:
Practice Address - Street 1:66 OAKWYNNE TER
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8525
Practice Address - Country:US
Practice Address - Phone:215-279-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1942239116Medicare UPIN