Provider Demographics
NPI:1932266327
Name:KUSSMAN, ROGER A (DDS)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:KUSSMAN
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 1:220 MONTGOMERY ST
Mailing Address - Street 2:STE #825
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104
Mailing Address - Country:US
Mailing Address - Phone:415-981-9000
Mailing Address - Fax:415-981-9006
Practice Address - Street 1:220 MONTGOMERY ST
Practice Address - Street 2:STE #825
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104
Practice Address - Country:US
Practice Address - Phone:415-981-9000
Practice Address - Fax:415-981-9006
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice