Provider Demographics
NPI:1508023342
Name:NUSSBAUM, MICHAEL BART (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BART
Last Name:NUSSBAUM
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 1:3660 STONERIDGE RD
Mailing Address - Street 2:B101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7760
Mailing Address - Country:US
Mailing Address - Phone:512-327-3631
Mailing Address - Fax:512-327-2234
Practice Address - Street 1:3660 STONERIDGE RD
Practice Address - Street 2:B101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7760
Practice Address - Country:US
Practice Address - Phone:512-327-3631
Practice Address - Fax:512-327-2234
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice