Provider Demographics
NPI:1831348549
Name:KUSE, KASUMI (DDS,PHD)
Entity type:Individual
Prefix:DR
First Name:KASUMI
Middle Name:
Last Name:KUSE
Suffix:
Gender:F
Credentials:DDS,PHD
Other - Prefix:DR
Other - First Name:KASUMI
Other - Middle Name:KUSE
Other - Last Name:BAROUCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,PHD
Mailing Address - Street 1:1265 BEACON ST
Mailing Address - Street 2:1004
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5200
Mailing Address - Country:US
Mailing Address - Phone:617-566-3680
Mailing Address - Fax:617-566-3679
Practice Address - Street 1:100 E NEWTON ST
Practice Address - Street 2:G-217
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-4762
Practice Address - Fax:617-638-6170
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA98511223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics