Provider Demographics
NPI:1699257535
Name:JOHN A. KUSH, D.M.D., LLC
Entity type:Organization
Organization Name:JOHN A. KUSH, D.M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-730-0090
Mailing Address - Street 1:47 LA COSTA DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-1663
Mailing Address - Country:US
Mailing Address - Phone:908-730-7119
Mailing Address - Fax:
Practice Address - Street 1:1484 HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801
Practice Address - Country:US
Practice Address - Phone:908-730-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental