Provider Demographics
NPI:1467794263
Name:MUSE, TAWNYA L (DMD)
Entity Type:Individual
Prefix:MRS
First Name:TAWNYA
Middle Name:L
Last Name:MUSE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 S HIGHWAY 27 STE 5
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-3073
Mailing Address - Country:US
Mailing Address - Phone:606-678-0978
Mailing Address - Fax:606-678-9218
Practice Address - Street 1:3810 S HIGHWAY 27 STE 5
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3073
Practice Address - Country:US
Practice Address - Phone:606-678-0978
Practice Address - Fax:606-678-9218
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY66721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60066727Medicaid