Provider Demographics
NPI:1518199629
Name:DUSENBURY, JOHN ANTHONY JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:DUSENBURY
Suffix:JR
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 1:11139 ABERCORN ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1829
Mailing Address - Country:US
Mailing Address - Phone:912-925-9190
Mailing Address - Fax:
Practice Address - Street 1:11139 ABERCORN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1829
Practice Address - Country:US
Practice Address - Phone:912-925-9190
Practice Address - Fax:912-925-9191
Is Sole Proprietor?:No
Enumeration Date:2009-08-23
Last Update Date:2015-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4655122300000X
GADN0150741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist