Provider Demographics
NPI:1447328703
Name:KUSHNER, BENN MARVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:BENN
Middle Name:MARVIN
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 SW 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7121
Mailing Address - Country:US
Mailing Address - Phone:954-797-4936
Mailing Address - Fax:954-587-9738
Practice Address - Street 1:5651 SW 64TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7121
Practice Address - Country:US
Practice Address - Phone:954-797-4936
Practice Address - Fax:954-587-9738
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 64171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice