Provider Demographics
NPI:1750378493
Name:CHUSID, ALAN D (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:CHUSID
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 1:22 DUKE DR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1017
Mailing Address - Country:US
Mailing Address - Phone:516-642-8764
Mailing Address - Fax:
Practice Address - Street 1:22 DUKE DR
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1017
Practice Address - Country:US
Practice Address - Phone:516-642-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY389011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice