Provider Demographics
NPI:1861825150
Name:CUSHMAN, CHRISTINA VICTORIA (RDH)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:VICTORIA
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:CUSHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SAN JUAN VW
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SAN JUAN VW
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-2350
Practice Address - Country:US
Practice Address - Phone:787-555-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics