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NPI Code Detail

MEDICARE: DR. GARY R KUSHNER DDS

MEDICARE: DR. GARY R KUSHNER DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223D0001XPublic Health DentistryNC 4858NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1015N0OTHERNCNC HEALTH CHOICE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144240854
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY R KUSHNER DDS
Provider Business Mailing Address
First Line : 1801 ROZZELLES FERRY RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-4228
Country : US
Telephone Number : 704-350-7300
Fax Number : 704-350-7304
Provider Business Practice Location Address
First Line : 1801 ROZZELLES FERRY RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-4228
Country : US
Telephone Number : 704-350-7300
Fax Number : 704-350-7304
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 07/09/2007

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