Individual
BUDI KUSNOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
842 W 31ST ST, CHICAGO, IL 60608
(312) 804-8304
(312) 873-3803
Mailing address
47 W POLK ST, SUITE 251, CHICAGO, IL 60605-2000
(312) 804-8304
(312) 873-3803
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019022824
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021002161
IL
Other
Enumeration date
10/12/2006
Last updated
01/28/2014
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