Provider Demographics
NPI:1881861466
Name:COUSINEAU, DANIEL JAMES (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:COUSINEAU
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
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Mailing Address - Street 1:314 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2622
Mailing Address - Country:US
Mailing Address - Phone:734-241-3399
Mailing Address - Fax:734-241-4307
Practice Address - Street 1:314 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2622
Practice Address - Country:US
Practice Address - Phone:734-241-3399
Practice Address - Fax:734-241-4307
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI110211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics