Provider Demographics
NPI:1588037949
Name:JOSHUA COUSSA DMD, PA
Entity Type:Organization
Organization Name:JOSHUA COUSSA DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JON
Authorized Official - Last Name:COUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-290-4340
Mailing Address - Street 1:2171 NE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7616
Mailing Address - Country:US
Mailing Address - Phone:954-290-4340
Mailing Address - Fax:
Practice Address - Street 1:8235 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7450
Practice Address - Country:US
Practice Address - Phone:954-753-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-07
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty