Provider Demographics
NPI:1033592399
Name:KICKISH, ROSALIA APHRODITE (DMD)
Entity type:Individual
Prefix:DR
First Name:ROSALIA
Middle Name:APHRODITE
Last Name:KICKISH
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 1:13122 VAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7187
Mailing Address - Country:US
Mailing Address - Phone:813-638-0313
Mailing Address - Fax:813-677-1228
Practice Address - Street 1:13122 VAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7187
Practice Address - Country:US
Practice Address - Phone:813-638-0313
Practice Address - Fax:813-677-1228
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21102122300000X
SC8515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist