Individual
JOHN A CUSUMANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4350 N FAIRFAX DR #135, 4350 N FAIRFAX DR SUITE 135, ARLINGTON, VA 22203-1695
(703) 525-4071
(703) 525-0868
Mailing address
4350 N FAIRFAX DR #135, 4350 N FAIRFAX DR SUITE 135, ARLINGTON, VA 22203-1695
(703) 525-4071
(703) 525-0868
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401416545
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401416545
VA DEPARTMENT OF LICENSING
VA
Enumeration date
06/20/2019
Last updated
06/20/2019
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