Provider Demographics
NPI:1639101991
Name:KUSEK, EDWARD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:KUSEK
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 1:4921 E 26TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-6967
Mailing Address - Country:US
Mailing Address - Phone:605-371-3443
Mailing Address - Fax:605-371-3445
Practice Address - Street 1:4921 E 26TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-6967
Practice Address - Country:US
Practice Address - Phone:605-371-3443
Practice Address - Fax:605-371-3445
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM6581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice