Organization
CONRAD J KUSEL DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CONRAD JAMES KUSEL JR. DDS (PRESIDENT)
(772) 878-7525
Entity
Organization
Contact information
Practice address
491 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34953-2044
(772) 878-7525
(772) 340-1807
Mailing address
491 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34953-2044
(772) 878-7525
(772) 340-1807
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN-0011106
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043426778
GENRAL DENTISTRY
FL
01
—
1912113606
GENERAL DENTISTRY
FL
Enumeration date
03/20/2012
Last updated
03/20/2012
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