Provider Demographics
NPI:1710253000
Name:ALAN KUSHNER, D.D.S. & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ALAN KUSHNER, D.D.S. & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-438-3669
Mailing Address - Street 1:21828 N VESPER CT
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9740
Mailing Address - Country:US
Mailing Address - Phone:847-438-3669
Mailing Address - Fax:
Practice Address - Street 1:710 W BRINK ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-2720
Practice Address - Country:US
Practice Address - Phone:815-943-5939
Practice Address - Fax:815-943-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A146071223G0001X
IL0190240981223G0001X
IL0190268051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty