Provider Demographics
NPI:1225161417
Name:MUSELLA, ANTHONY E (DDS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
Last Name:MUSELLA
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 1:7760 W 38TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6147
Mailing Address - Country:US
Mailing Address - Phone:303-421-4010
Mailing Address - Fax:303-423-9051
Practice Address - Street 1:7760 W 38TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6147
Practice Address - Country:US
Practice Address - Phone:303-421-4010
Practice Address - Fax:303-423-9051
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1049231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02049237Medicaid
CO02049237Medicaid
COU21521Medicare UPIN