Organization
GUSTER LOSEY & MACK DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA REYNOLDS LOSEY (PARTNER)
(937) 642-8500
Entity
Organization
Contact information
Practice address
1055 W 5TH ST, MARYSVILLE, OH 43040-8668
(937) 642-8500
(937) 642-5474
Mailing address
1055 W 5TH ST, MARYSVILLE, OH 43040-8668
(937) 642-8500
(937) 642-5474
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30-022215
OH
1223G0001X
General Practice Dentistry
30021273
OH
1223G0001X
General Practice Dentistry
30023450
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2332685
—
OH
05
—
2663336
—
OH
05
—
3158130
—
OH
Enumeration date
03/03/2010
Last updated
10/19/2023
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