Provider Demographics
NPI:1093922734
Name:JAKUSZ, CYNTHIA (DDS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:JAKUSZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 BALL DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53076-9515
Mailing Address - Country:US
Mailing Address - Phone:262-644-0335
Mailing Address - Fax:
Practice Address - Street 1:N112W16760 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-5814
Practice Address - Country:US
Practice Address - Phone:262-255-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5490-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice