Provider Demographics
NPI:1902512593
Name:MUSSELMAN DENTISTRY PLLC
Entity type:Organization
Organization Name:MUSSELMAN DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:MUSSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-520-9353
Mailing Address - Street 1:1277 E MISSOURI AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2916
Mailing Address - Country:US
Mailing Address - Phone:602-277-4464
Mailing Address - Fax:
Practice Address - Street 1:1277 E MISSOURI AVE STE 111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2916
Practice Address - Country:US
Practice Address - Phone:602-277-4464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental