MEDICARE: WISNIEWSKI DENTISTRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1346137452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISNIEWSKI DENTISTRY LLC

Provider Business Mailing Address
First Line	:	46 VREELAND DR STE 3
Second Line	:
City	:	SKILLMAN
State	:	NJ
Zip	:	08558-2638
Country	:	US
Telephone Number	:	609-924-4421
Fax Number	:	609-921-3287

Provider Business Practice Location Address
First Line	:	46 VREELAND DR STE 3
Second Line	:
City	:	SKILLMAN
State	:	NJ
Zip	:	08558-2638
Country	:	US
Telephone Number	:	609-924-4421
Fax Number	:	609-921-3287

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. VERONICA WISNIEWSKI
Credential	:	DMD
Telephone Number	:	609-924-4421

Provider Enumeration Date	:	06/20/2025
Last Update Date	:	06/20/2025

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