Healthcare Provider Details

I. General information

NPI: 1831440510
Provider Name (Legal Business Name): ROBERT B. CUSHING DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 49TH ST SUITE 400
HIALEAH FL
33012-3402
US

IV. Provider business mailing address

900 W 49TH ST SUITE 400
HIALEAH FL
33012-3402
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-1211
  • Fax: 305-557-6360
Mailing address:
  • Phone: 305-558-1211
  • Fax: 305-557-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN5112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: