Provider Demographics
NPI:1699052779
Name:MUHUSIN, TYKEISHA DENISE (DDS)
Entity type:Individual
Prefix:DR
First Name:TYKEISHA
Middle Name:DENISE
Last Name:MUHUSIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 GRAVES AVE
Mailing Address - Street 2:SUITE 11E
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5013
Mailing Address - Country:US
Mailing Address - Phone:408-668-4144
Mailing Address - Fax:
Practice Address - Street 1:5150 GRAVES AVE
Practice Address - Street 2:SUITE 11E
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5013
Practice Address - Country:US
Practice Address - Phone:408-668-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2013-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA609141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice