Provider Demographics
NPI:1194856278
Name:DR. ALBERT M. STUSH, JR.
Entity Type:Organization
Organization Name:DR. ALBERT M. STUSH, JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STUSH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:570-524-9866
Mailing Address - Street 1:142 FARLEY CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9243
Mailing Address - Country:US
Mailing Address - Phone:570-524-9866
Mailing Address - Fax:570-524-9188
Practice Address - Street 1:142 FARLEY CIR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9243
Practice Address - Country:US
Practice Address - Phone:570-524-9866
Practice Address - Fax:570-524-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021310L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty