Individual
KEVIN JONATHAN KISICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
13940 BALTIMORE-WASHINGTON BLVD, LAUREL, MD 20707
(301) 369-0000
(301) 369-0031
Mailing address
9806 LINDEN HILL RD, OWINGS MILLS, MD 21117-6100
(443) 660-8032
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13477
MD
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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