Provider Demographics
NPI:1659788271
Name:BUSSELL, ADAM PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PETER
Last Name:BUSSELL
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 1:571 YOPP RD STE 308
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-3683
Mailing Address - Country:US
Mailing Address - Phone:910-716-0101
Mailing Address - Fax:910-294-8874
Practice Address - Street 1:571 YOPP RD STE 308
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-3683
Practice Address - Country:US
Practice Address - Phone:910-716-0101
Practice Address - Fax:910-294-8874
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63640122300000X
NC125671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist