Healthcare Provider Details

I. General information

NPI: 1639008253
Provider Name (Legal Business Name): KACIE WARSHOWSKY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S 40TH ST
PHILADELPHIA PA
19104-6030
US

IV. Provider business mailing address

121 N 21ST ST APT 1R
PHILADELPHIA PA
19103-1449
US

V. Phone/Fax

Practice location:
  • Phone: 215-898-8965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number14679
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: