Provider Demographics
NPI:1366922676
Name:DR. KENNETH TUSHA DDS
Entity type:Organization
Organization Name:DR. KENNETH TUSHA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUSHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-394-7254
Mailing Address - Street 1:309 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68718-4035
Mailing Address - Country:US
Mailing Address - Phone:402-668-2297
Mailing Address - Fax:402-668-2297
Practice Address - Street 1:309 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NE
Practice Address - Zip Code:68718-4035
Practice Address - Country:US
Practice Address - Phone:402-668-2297
Practice Address - Fax:402-668-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5042261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental