Provider Demographics
NPI:1922137074
Name:BUSETTI, ROBERT (DOCTOR OF DENTAL SUR)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BUSETTI
Suffix:
Gender:M
Credentials:DOCTOR OF DENTAL SUR
Other - Prefix:DR
Other - First Name:B
Other - Middle Name:
Other - Last Name:BUSETTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12713
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66282-2713
Mailing Address - Country:US
Mailing Address - Phone:913-492-6438
Mailing Address - Fax:
Practice Address - Street 1:10346 STATE LINE ROAD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206
Practice Address - Country:US
Practice Address - Phone:913-492-6438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13763122300000X
KS5877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U19099Medicare UPIN