Provider Demographics
NPI:1174638357
Name:KUSSMAN, TAMMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:
Last Name:KUSSMAN
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 1:783 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4508
Mailing Address - Country:US
Mailing Address - Phone:615-346-3007
Mailing Address - Fax:615-346-3005
Practice Address - Street 1:783 OLD HICKORY BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4508
Practice Address - Country:US
Practice Address - Phone:615-346-3007
Practice Address - Fax:615-346-3005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS7354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist