Provider Demographics
NPI:1144396565
Name:CUSHING, JOHN RENOUARD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RENOUARD
Last Name:CUSHING
Suffix:JR
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 1:1976 WARBLER CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-649-1498
Mailing Address - Fax:
Practice Address - Street 1:4216 PONTIAC LAKE ROAD
Practice Address - Street 2:GREAT EXPRESSIONS
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328
Practice Address - Country:US
Practice Address - Phone:248-674-1009
Practice Address - Fax:248-674-9615
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI112431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice