Provider Demographics
NPI:1184036642
Name:KUSBEL, MARISOL (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:
Last Name:KUSBEL
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 1:1240 SACRAMENTO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-4208
Mailing Address - Country:US
Mailing Address - Phone:210-909-6012
Mailing Address - Fax:
Practice Address - Street 1:7318 W MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-2947
Practice Address - Country:US
Practice Address - Phone:210-673-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice