MEDICARE: JANET VISANESCU D.M.D.

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	1223G0001X	General Practice Dentistry	5708	KY

General Provider Information

NPI Number	:	1316080765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET VISANESCU D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 470
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-0470
Country	:	US
Telephone Number	:	502-222-7874
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 E ADAMS ST STE 1
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-1278
Country	:	US
Telephone Number	:	502-222-7874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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