MEDICARE: BRUCE A KUSHNER D.M.D.

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
1	1223G0001X	General Practice Dentistry	DN 9257	FL

General Provider Information

NPI Number	:	1164623641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE A KUSHNER D.M.D.

Provider Business Mailing Address
First Line	:	10690 S US HIGHWAY 1
Second Line	:	SUITE A
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-6411
Country	:	US
Telephone Number	:	772-335-3300
Fax Number	:	772-398-9773

Provider Business Practice Location Address
First Line	:	10690 S US HIGHWAY 1
Second Line	:	SUITE A
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-6411
Country	:	US
Telephone Number	:	772-335-3300
Fax Number	:	772-398-9773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	05/20/2013

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