Provider Demographics
NPI:1033647383
Name:KUSEK, EDWARD ALEX (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALEX
Last Name:KUSEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 WINGO WAY STE 301
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-1803
Mailing Address - Country:US
Mailing Address - Phone:843-884-2021
Mailing Address - Fax:
Practice Address - Street 1:317 WINGO WAY STE 301
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1803
Practice Address - Country:US
Practice Address - Phone:843-884-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD11501223G0001X
SC9467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice