Individual
NANA OWUSU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 LAKE AVE, RACINE, WI 53403-1020
(262) 633-0775
Mailing address
400 LAKE AVE, RACINE, WI 53403-1020
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6001017-15
WI
122300000X
Dentist
Primary
D14830
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/07/2022
Last updated
03/24/2026
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