Provider Demographics
NPI:1164680484
Name:FAMILY & IMPLANT DENTISTRY, LTD
Entity Type:Organization
Organization Name:FAMILY & IMPLANT DENTISTRY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-371-3443
Mailing Address - Street 1:4921 E 26TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-6967
Mailing Address - Country:US
Mailing Address - Phone:605-371-3443
Mailing Address - Fax:605-371-3445
Practice Address - Street 1:4921 E 26TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-6967
Practice Address - Country:US
Practice Address - Phone:605-371-3443
Practice Address - Fax:605-371-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM6581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty