Mark W Dusek, DDS
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Savannah, GA
NPI 1003236407 · NPPES record last updated Apr 24, 2014
Key facts
- NPI
- 1003236407
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- DNO12058 (GA)
- Practice address
- 500 Eisenhower Dr
Savannah, GA 31406-2608 - Phone
- (912) 355-7022
- Fax
- (912) 355-1415
- NPI assigned
- Apr 24, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DNO12058 | GA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| 3838 | SC | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DRS Broderick Vaught & Dusek PC | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DNO12058 | GA | Yes |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 3838 | SC |
Addresses
Primary practice location
500 Eisenhower Dr
Savannah, GA 31406-2608
Mailing address
500 Eisenhower Dr
Savannah, GA 31406-2608
Phone (912) 355-7022
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114017530 | Other | GA | GROUP NPI |
Other providers in Savannah, GA
- Christine Diane Durham
- Kelli Stephanie Durham
- Ryan Patrick Durkin
- Sean Joseph Durkin
- Madison Daughtry Durrence
- John Anthony Dusenbury Jr.
- John R Duttenhaver
- Benjamin Thomas Duval
- Sara Paige Duvall
- Dva Renal Healthcare Inc
All providers in Savannah, GA · Orthodontics and Dentofacial Orthopedics Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.