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General NPI Number Information
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NPI Number | 1033447867
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Entity Type | Individual
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Provider Name | DR. KENNETH CHIUSANO
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Gender | Male
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 2031 HAY TERRACE
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City | EASTON
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State | PA
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Zip | 18042
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Country | US
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Telephone | 570-402-4001
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Fax | 570-402-4002
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Provider Business Mailing Address
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Address Line | PO BOX 200 OLD MILL PROFESSIONAL CENTER, BUSINESS RT. 209
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City | SCIOTA
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State | PA
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Zip | 18354-0210
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS037839
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License Number State | PA
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