Provider Demographics
NPI:1881715191
Name:KISSELL, DENISE (DDS)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:KISSELL
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:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-0545
Mailing Address - Country:US
Mailing Address - Phone:508-477-0724
Mailing Address - Fax:
Practice Address - Street 1:96 OLD BARNSTABLE RD
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3286
Practice Address - Country:US
Practice Address - Phone:508-477-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18556221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice