Provider Demographics
NPI:1902056872
Name:KUJAK, DAVID L (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:KUJAK
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8668
Mailing Address - Country:US
Mailing Address - Phone:608-783-8333
Mailing Address - Fax:608-783-5942
Practice Address - Street 1:1845 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8668
Practice Address - Country:US
Practice Address - Phone:608-783-8333
Practice Address - Fax:608-783-5942
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8676122300000X
TNDS92521223X0400X
WI69491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist