Healthcare Provider Details

I. General information

NPI: 1851212401
Provider Name (Legal Business Name): SARAH RANDI WISKOSKI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-6661
US

IV. Provider business mailing address

5233 ROLLING HILLS RD # 5233
SAYLORSBURG PA
18353-8052
US

V. Phone/Fax

Practice location:
  • Phone: 570-236-5991
  • Fax:
Mailing address:
  • Phone: 570-236-5991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00206772
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: