Provider Demographics
NPI:1558538637
Name:BUSCIGLIO, DAVID J (DMD PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BUSCIGLIO
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 LUMSDEN PROFESSIONAL COURT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-685-6200
Mailing Address - Fax:813-200-3910
Practice Address - Street 1:611 LUMSDEN PROFESSIONAL COURT
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-685-6200
Practice Address - Fax:813-200-3910
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN137641223G0001X, 332B00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6580880001Medicare NSC