Provider Demographics
NPI:1245957372
Name:MUSSO, DONNA L (RDH)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:MUSSO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:L
Other - Last Name:RAMPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:110 E ROUTT AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2117
Mailing Address - Country:US
Mailing Address - Phone:719-543-8711
Mailing Address - Fax:719-543-0171
Practice Address - Street 1:2030 LAKE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3536
Practice Address - Country:US
Practice Address - Phone:719-564-4823
Practice Address - Fax:719-564-4858
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2839124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist