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General NPI Number Information
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NPI Number | 1215202502
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Entity Type | Organization
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Legal Business Name | CONRAD J KUSEL DDS PA
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 491 SW PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-2044
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Country | US
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Telephone | 772-878-7525
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Fax | 772-340-1807
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Provider Business Mailing Address
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Address Line | 491 SW PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-2044
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Country | US
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Telephone | 772-878-7525
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Fax | 772-340-1807
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CONRAD JAMES KUSEL JR.
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Credential | DDS
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Telephone | 772-878-7525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN-0011106
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License Number State | FL
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