Provider Demographics
NPI:1053487850
Name:PUSEY, ROBERT DRAKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DRAKE
Last Name:PUSEY
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 1:209 WEST SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:IA
Mailing Address - Zip Code:52654-0217
Mailing Address - Country:US
Mailing Address - Phone:319-256-4065
Mailing Address - Fax:
Practice Address - Street 1:209 W. 2ND ST
Practice Address - Street 2:
Practice Address - City:WAYLAND, IA, 52654
Practice Address - State:IA
Practice Address - Zip Code:52654
Practice Address - Country:US
Practice Address - Phone:319-256-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA67891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice