Provider Demographics
NPI:1316080765
Name:VISANESCU, JANET (DMD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:VISANESCU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-0470
Mailing Address - Country:US
Mailing Address - Phone:502-222-7874
Mailing Address - Fax:
Practice Address - Street 1:120 E ADAMS ST STE 1
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1278
Practice Address - Country:US
Practice Address - Phone:502-222-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY57081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice