Provider Demographics
NPI:1134881873
Name:MUSHEINESH, LUSYA (RDH)
Entity type:Individual
Prefix:
First Name:LUSYA
Middle Name:
Last Name:MUSHEINESH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13901 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2720
Mailing Address - Country:US
Mailing Address - Phone:313-281-2591
Mailing Address - Fax:313-855-2900
Practice Address - Street 1:7900 KERCHEVAL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2439
Practice Address - Country:US
Practice Address - Phone:313-921-5500
Practice Address - Fax:313-922-0824
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist