Provider Demographics
NPI:1467619890
Name:MUSSO, FEDELE ANTHONY (DMD)
Entity Type:Individual
Prefix:
First Name:FEDELE
Middle Name:ANTHONY
Last Name:MUSSO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STATION SQUARE 2
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301
Mailing Address - Country:US
Mailing Address - Phone:610-644-1502
Mailing Address - Fax:610-296-7915
Practice Address - Street 1:STATION SQUARE 2
Practice Address - Street 2:SUITE 111
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-644-1502
Practice Address - Fax:610-296-7915
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 019136-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice