Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 3838 | SC |
Y | 1223X0400X | Orthodontists | DNO12058 | GA |
NPI | 1003236407 |
---|---|
Provider Name | Dr. Mark W Dusek |
First Address | Savannah, GA 31406-2608 |
Second Address | Savannah, GA 31406-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2014 |
Last Update Date | 24/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114017530 | GROUP NPI (01) | GA |