Individual
LAURA WYSOCKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-4321
Mailing address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-4321
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
060451
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/27/2017
Last updated
09/17/2020
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