Provider Demographics
NPI:1871669150
Name:KANYUSIK, JOHN STEPHEN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHEN
Last Name:KANYUSIK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:120 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3501
Mailing Address - Country:US
Mailing Address - Phone:507-388-2989
Mailing Address - Fax:507-388-2985
Practice Address - Street 1:120 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3501
Practice Address - Country:US
Practice Address - Phone:507-388-2989
Practice Address - Fax:507-388-2985
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN75611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics