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Contact Information

CLARENCE E KUSIK
N50 W34838 WISCONSIN AVE.
OKAUCHEE, WI53069
 Phone: 262-567-3171
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
 

Dental

261QD0000X
Indicates primary specialty

NPI Profile & details for CLARENCE E KUSIK · (Male)

NPI Number 1245407550
Status Active
Credentials
Entity Individual
Enumeration date 05/15/2008
Last updated 02/03/2022 - About 4 years ago
Sole proprietor 1 Yes
Identifiers
  • WI License # 5000432-15
  • WI License # 5000432015
  • WI Medicaid 33506100
  • WI Medicaid 38380800
  • Other 1831369008 MAYFAIR DENTAL S.C.
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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