Provider Demographics
NPI:1558466565
Name:BUSSMAN, PAUL D (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:BUSSMAN
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 1:135 COUNTY ROAD 278
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057-4887
Mailing Address - Country:US
Mailing Address - Phone:256-736-6048
Mailing Address - Fax:
Practice Address - Street 1:1625 MAIN AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5230
Practice Address - Country:US
Practice Address - Phone:256-734-1700
Practice Address - Fax:256-739-1984
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice