MEDICARE: DR. GEORGE VISNICH 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS-025816-L	PA

General Provider Information

NPI Number	:	1710018353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE VISNICH D.M.D.

Provider Business Mailing Address
First Line	:	100 N PARK RD APT 1119
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-3047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	744 E LINCOLN HWY STE 110
Second Line	:
City	:	COATESVILLE
State	:	PA
Zip	:	19320-3590
Country	:	US
Telephone Number	:	717-299-6371
Fax Number	:

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/18/2025

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