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Provider Information for 1275648701



BRYAN PHILLIP COUSIN DMD

Gender: MALE

Individual NPI: 1275648701

Calendar   Last Updated:  2015-02-03
  Certification Date: 

Details

Name Value
NPI 1275648701
Enumeration Date 2006-08-21
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 205 WESTERN AVE
LYNN, MA 01904-2745
United States

Phone: 781-598-1180 | Fax:
View Map External Link
Primary Practice Address 205 WESTERN AVE
LYNN, MA 01904-2745
United States

Phone: 781-598-1180 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice MA 14341