Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kerollos Wissa

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1376301697

Kerollos Wissa is a Student in an Organized Health Care Education/Training Program in Boston, Massachusetts. Practices as a sole proprietor and works from 2 locations. Licensed in Florida.

Licensed in
FL
In the registry since
2024
Specialties on file
2
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Practice location Address checks out

635 Albany St
Boston, MA 02118-3550
Phone: (617) 358-8300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1617 Catalina Blvd, Deltona, FL 32725-9699 — (386) 457-4520

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence DN29645 (FL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1376301697
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 11, 2024
Last updated in NPPESOctober 4, 2024
Certification dateOctober 4, 2024
Mailing address1461 Terra Verde Way, Ocoee, FL 34761-8467

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