Provider Demographics
NPI:1447486642
Name:KRUSICH, IAN JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:JAMES
Last Name:KRUSICH
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 1:11111 NALL AVE
Mailing Address - Street 2:106
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1924
Mailing Address - Country:US
Mailing Address - Phone:913-383-2600
Mailing Address - Fax:
Practice Address - Street 1:11111 NALL AVE
Practice Address - Street 2:106
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1924
Practice Address - Country:US
Practice Address - Phone:913-383-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist