Provider Demographics
NPI:1629134317
Name:HUSSON, MALINDA MAYNARD (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:MALINDA
Middle Name:MAYNARD
Last Name:HUSSON
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 MACCORKLE AVE SE STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1835
Mailing Address - Country:US
Mailing Address - Phone:304-926-9260
Mailing Address - Fax:304-926-9266
Practice Address - Street 1:4502 MACCORKLE AVE SE STE C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1835
Practice Address - Country:US
Practice Address - Phone:304-926-9260
Practice Address - Fax:304-926-9266
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410708122300000X, 207L00000X
WV3557122300000X, 1223D0004X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223D0004XDental ProvidersDentistDentist Anesthesiologist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology