Provider Demographics
NPI:1386974921
Name:JOSEPH G. BUSSELL, DDS, PA
Entity type:Organization
Organization Name:JOSEPH G. BUSSELL, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:BUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-868-1300
Mailing Address - Street 1:6020 RANCH DR
Mailing Address - Street 2:SUITE C6
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4621
Mailing Address - Country:US
Mailing Address - Phone:501-868-1300
Mailing Address - Fax:501-868-1327
Practice Address - Street 1:6020 RANCH DR
Practice Address - Street 2:SUITE C6
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4621
Practice Address - Country:US
Practice Address - Phone:501-868-1300
Practice Address - Fax:501-868-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2839261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental