Healthcare Provider Details

I. General information

NPI: 1659298131
Provider Name (Legal Business Name): JUSKA DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 PARK BLVD APT 312
SAN DIEGO CA
92103-0917
US

IV. Provider business mailing address

3740 PARK BLVD APT 312
SAN DIEGO CA
92103-0917
US

V. Phone/Fax

Practice location:
  • Phone: 630-915-1563
  • Fax:
Mailing address:
  • Phone: 630-915-1563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: TOMAS JUSKA
Title or Position: CEO
Credential: DMD
Phone: 630-915-1563