Healthcare Provider Details

I. General information

NPI: 1518168004
Provider Name (Legal Business Name): KEVAN KUSHNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 US HIGHWAY 9
HOWELL NJ
07731-3359
US

IV. Provider business mailing address

5170 US HIGHWAY 9
HOWELL NJ
07731-3359
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-8600
  • Fax:
Mailing address:
  • Phone: 732-367-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10342
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: