Provider Demographics
NPI:1215254610
Name:KUSELL, MAURINA LINDA (DDS)
Entity type:Individual
Prefix:
First Name:MAURINA
Middle Name:LINDA
Last Name:KUSELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 STATION WAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3359
Mailing Address - Country:US
Mailing Address - Phone:805-489-6650
Mailing Address - Fax:
Practice Address - Street 1:260 STATION WAY
Practice Address - Street 2:SUITE E
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3359
Practice Address - Country:US
Practice Address - Phone:805-489-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice