Provider Demographics
NPI:1730501917
Name:DENNIS J. CUSTER, D.D.S., LLC
Entity Type:Organization
Organization Name:DENNIS J. CUSTER, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-756-0321
Mailing Address - Street 1:564 S TRIMBLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3418
Mailing Address - Country:US
Mailing Address - Phone:419-756-0321
Mailing Address - Fax:419-756-4430
Practice Address - Street 1:564 S TRIMBLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3418
Practice Address - Country:US
Practice Address - Phone:419-756-0321
Practice Address - Fax:419-756-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17639332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment