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Individual
EDWARD VANISKY
Active
Individual
EDWARD VANISKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN22199
MA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS030512L
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DN22199
MA
Other
Enumeration date
12/14/2005
Last updated
05/09/2019
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