Provider Demographics
NPI:1982787438
Name:MUSSONE, DAVID G (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:MUSSONE
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 1:650 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-1672
Mailing Address - Country:US
Mailing Address - Phone:541-267-3977
Mailing Address - Fax:
Practice Address - Street 1:650 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1672
Practice Address - Country:US
Practice Address - Phone:541-267-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD90731223G0001X
HIDT22621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice