Provider Demographics
NPI:1063599694
Name:LUSZCZAK, ROBERT J (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:LUSZCZAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10718 WHITE OAK AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4628
Mailing Address - Country:US
Mailing Address - Phone:818-363-7484
Mailing Address - Fax:818-366-8465
Practice Address - Street 1:10718 WHITE OAK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4628
Practice Address - Country:US
Practice Address - Phone:818-363-7484
Practice Address - Fax:818-366-8465
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL29615361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice