Provider Demographics
NPI:1811005903
Name:RICHARD L ZUSSMAN DDS MS SC
Entity Type:Organization
Organization Name:RICHARD L ZUSSMAN DDS MS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORP ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ZUSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:414-351-1939
Mailing Address - Street 1:8651 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217
Mailing Address - Country:US
Mailing Address - Phone:414-351-1939
Mailing Address - Fax:414-351-6689
Practice Address - Street 1:8411 W LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:414-321-7240
Practice Address - Fax:414-321-9754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50012511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty