Individual
DR. CLARENCE E KUSIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
N50 W34838 WISCONSIN AVE., OKAUCHEE, WI 53069
(262) 567-3171
Mailing address
N50 W34838 WISCONSIN AVE., OKAUCHEE, WI 53069
(262) 567-3171
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5000432015
WI
261QD0000X
Dental Clinic/Center
5000432-15
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831369008
MAYFAIR DENTAL S.C.
—
05
—
33506100
—
WI
05
—
38380800
—
WI
Enumeration date
05/15/2008
Last updated
02/03/2022
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