Provider Demographics
NPI:1528070497
Name:WICZER, ROANNE J (DMD)
Entity type:Individual
Prefix:DR
First Name:ROANNE
Middle Name:J
Last Name:WICZER
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 1:8311 WISCONSIN AVE
Mailing Address - Street 2:SUITE B-B
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-466-8026
Mailing Address - Fax:
Practice Address - Street 1:8311 WISCONSIN AVE
Practice Address - Street 2:SUITE B-8
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3126
Practice Address - Country:US
Practice Address - Phone:301-913-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice