Kusom Pediatric Dental South PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

KUSOM PEDIATRIC DENTAL SOUTH PLLC

Doing business as

Great Kids Dental

Practice address

1134 Culebra Rd Ste 109
San Antonio, TX 78201-6080

Phone

(210) 888-0700

Fax

(210) 625-7398

NPI assigned

Dec 31, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Oshmi Dutta, MD

Title

Ceo

Phone

(210) 888-0700

Specialties & licenses 1

Addresses

Other names 1

• Great Kids Dental Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1577750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1669011235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18707 HARDY OAK BLVD STE 305",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584895",
            "telephone_number": "210-888-0700",
            "fax_number": "210-625-7398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1134 CULEBRA RD STE 109",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782016080",
            "telephone_number": "210-888-0700",
            "fax_number": "210-625-7398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KUSOM PEDIATRIC DENTAL SOUTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-31",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "DUTTA",
        "authorized_official_first_name": "OSHMI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "210-888-0700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Kids Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great Kids Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Isanely Guerrero Kurz, LPC
• Marisol Kusbel, D.D.S
• Leann Kuser, PHARMD
• Melissa Kushnick
• Kusom Dental Broadway PLLC
• Ashleigh Marie Kussman, M.D.
• Alexi Kutac
• Marion Kutac
• Kutik-Giampaolo Hearing, Inc.
• Nita Elizabeth Kuttikandathil, MD

• Pediatric Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.