Provider Demographics
NPI:1952927642
Name:VISOCKI, KATHLEEN PATRICIA (RDH)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:VISOCKI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SYLVAN PL
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1730
Mailing Address - Country:US
Mailing Address - Phone:201-384-6018
Mailing Address - Fax:
Practice Address - Street 1:420 SYLVAN PL
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1730
Practice Address - Country:US
Practice Address - Phone:201-384-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22HI00768300124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist