Provider Demographics
NPI:1629099361
Name:TRUSSELL, DAVID W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:TRUSSELL
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 1:176 OCEAN HOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107
Mailing Address - Country:US
Mailing Address - Phone:207-767-3211
Mailing Address - Fax:207-767-3451
Practice Address - Street 1:176 OCEAN HOUSE ROAD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107
Practice Address - Country:US
Practice Address - Phone:207-767-3211
Practice Address - Fax:207-767-3451
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME23231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice