Provider Demographics
NPI:1104317189
Name:DUSEK, PAUL BENEDICT (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BENEDICT
Last Name:DUSEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 BRIGGS AVE S STE 3
Mailing Address - Street 2:
Mailing Address - City:PARK RIVER
Mailing Address - State:ND
Mailing Address - Zip Code:58270-4045
Mailing Address - Country:US
Mailing Address - Phone:701-284-7777
Mailing Address - Fax:
Practice Address - Street 1:321 BRIGGS AVE S STE 3
Practice Address - Street 2:
Practice Address - City:PARK RIVER
Practice Address - State:ND
Practice Address - Zip Code:58270
Practice Address - Country:US
Practice Address - Phone:701-284-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist