Provider Demographics
NPI:1396868121
Name:KUSHNIR, IRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:KUSHNIR
Suffix:
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 1:120 W WENGER RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2725
Mailing Address - Country:US
Mailing Address - Phone:937-836-1206
Mailing Address - Fax:937-836-3620
Practice Address - Street 1:120 W WENGER RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2725
Practice Address - Country:US
Practice Address - Phone:937-836-1206
Practice Address - Fax:937-836-3620
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-37001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry