Provider Demographics
NPI:1700099637
Name:SLUSAR, ROBERT J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:SLUSAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 N OAKLAND AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1586
Mailing Address - Country:US
Mailing Address - Phone:217-875-5010
Mailing Address - Fax:
Practice Address - Street 1:2727 N OAKLAND AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1586
Practice Address - Country:US
Practice Address - Phone:217-875-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics