Individual
DR. MICHAEL ROBERT CUSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
2323 W 2ND AVE STE B, DURANGO, CO 81301-4646
(970) 274-0074
(309) 699-7050
Mailing address
2323 W 2ND AVE STE B, DURANGO, CO 81301-4646
(505) 327-6155
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DEN.00204574
CO
1223G0001X
General Practice Dentistry
Primary
019-027507
IL
1223G0001X
General Practice Dentistry
DD3375
NM
Other
Enumeration date
09/25/2007
Last updated
04/15/2025
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