Provider Demographics
NPI:1427103456
Name:KUSIENSKI, MARGOT T (DMD, MSED, MMSC)
Entity type:Individual
Prefix:DR
First Name:MARGOT
Middle Name:T
Last Name:KUSIENSKI
Suffix:
Gender:F
Credentials:DMD, MSED, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHLANDS DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7693
Mailing Address - Country:US
Mailing Address - Phone:717-625-1901
Mailing Address - Fax:717-625-1902
Practice Address - Street 1:100 HIGHLANDS DR
Practice Address - Street 2:SUITE 302
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7693
Practice Address - Country:US
Practice Address - Phone:717-625-1901
Practice Address - Fax:717-625-1902
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO294719L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics