Provider Demographics
NPI:1619069663
Name:FRANCIS J. CUSUMANO D.D.S., P.A.
Entity Type:Organization
Organization Name:FRANCIS J. CUSUMANO D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CUSUMANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-819-4288
Mailing Address - Street 1:2054 KILDAIRE FARM RD # 425
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6614
Mailing Address - Country:US
Mailing Address - Phone:919-661-1995
Mailing Address - Fax:919-861-9718
Practice Address - Street 1:103 PARKWAY OFFICE CT
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7428
Practice Address - Country:US
Practice Address - Phone:919-661-1995
Practice Address - Fax:919-661-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916690Medicaid