Provider Demographics
NPI:1558498295
Name:MUSE, JOHN HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOWARD
Last Name:MUSE
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 1:755 COMMERCE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2627
Mailing Address - Country:US
Mailing Address - Phone:404-634-2234
Mailing Address - Fax:
Practice Address - Street 1:755 COMMERCE DR
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2627
Practice Address - Country:US
Practice Address - Phone:404-634-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0101541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU83663Medicare UPIN
GAGRP3862Medicare ID - Type Unspecified