Provider Demographics
NPI:1518151778
Name:JUSZAK, EDWIN JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:JOHN
Last Name:JUSZAK
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 1:2711 S ALMA SCHOOL RD
Mailing Address - Street 2:10
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4022
Mailing Address - Country:US
Mailing Address - Phone:480-820-3755
Mailing Address - Fax:
Practice Address - Street 1:2711 S ALMA SCHOOL RD
Practice Address - Street 2:10
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4022
Practice Address - Country:US
Practice Address - Phone:480-820-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist