MEDICARE: DR. EDWARD ALEX KUSEK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9467	SC
2	1223G0001X	General Practice Dentistry	D1150	SD

General Provider Information

NPI Number	:	1033647383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD ALEX KUSEK DDS

Provider Business Mailing Address
First Line	:	317 WINGO WAY STE 301
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-1803
Country	:	US
Telephone Number	:	843-884-2021
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 WINGO WAY STE 301
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-1803
Country	:	US
Telephone Number	:	843-884-2021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	09/24/2025

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