Provider Demographics
NPI:1164623641
Name:KUSHNER, BRUCE A (DMD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10690 S US HIGHWAY 1
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6411
Mailing Address - Country:US
Mailing Address - Phone:772-335-3300
Mailing Address - Fax:772-398-9773
Practice Address - Street 1:10690 S US HIGHWAY 1
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6411
Practice Address - Country:US
Practice Address - Phone:772-335-3300
Practice Address - Fax:772-398-9773
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 92571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice