Provider Demographics
NPI:1679096747
Name:NATHAN NUSSEN DDS PLLC
Entity Type:Organization
Organization Name:NATHAN NUSSEN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-909-8232
Mailing Address - Street 1:8510 ALMEDA GENOA RD STE 401A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-2243
Mailing Address - Country:US
Mailing Address - Phone:561-909-8232
Mailing Address - Fax:
Practice Address - Street 1:8510 ALMEDA GENOA RD STE 401A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-2243
Practice Address - Country:US
Practice Address - Phone:561-909-8232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty