Provider Demographics
NPI:1861806143
Name:KUSHION DENTAL, PLLC
Entity type:Organization
Organization Name:KUSHION DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-245-9669
Mailing Address - Street 1:1858 LAKE CIRCLE DR W
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-9452
Mailing Address - Country:US
Mailing Address - Phone:989-245-9669
Mailing Address - Fax:
Practice Address - Street 1:305 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL FALLS
Practice Address - State:MI
Practice Address - Zip Code:49920-1426
Practice Address - Country:US
Practice Address - Phone:906-875-6301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010212791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty