Provider Demographics
NPI:1518917343
Name:KUSHNER, GEORGE (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S. PRESTON ST.
Mailing Address - Street 2:SCHOOL OF DENTISTRY, SUITE 334
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40292-0001
Mailing Address - Country:US
Mailing Address - Phone:502-852-4171
Mailing Address - Fax:502-852-1973
Practice Address - Street 1:501 S. PRESTON ST.
Practice Address - Street 2:SCHOOL OF DENTISTRY, SUITE 334
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40292-0001
Practice Address - Country:US
Practice Address - Phone:502-852-4171
Practice Address - Fax:502-852-1973
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29938204E00000X
KY59011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60059011Medicaid
KY6405901700Medicaid
KY60059011Medicaid
KY6405901700Medicaid