Provider Demographics
NPI:1851353957
Name:LUSSIER, JAMES DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVID
Last Name:LUSSIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:204 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5809
Mailing Address - Country:US
Mailing Address - Phone:830-895-3494
Mailing Address - Fax:830-896-3390
Practice Address - Street 1:204 WESLEY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5809
Practice Address - Country:US
Practice Address - Phone:830-895-3494
Practice Address - Fax:830-896-3390
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202861223G0001X, 1223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery