Provider Demographics
NPI:1336573518
Name:MUSSER, VANESSA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:M
Last Name:MUSSER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 5TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6190
Mailing Address - Country:US
Mailing Address - Phone:815-546-6513
Mailing Address - Fax:
Practice Address - Street 1:247 5TH ST APT B
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6190
Practice Address - Country:US
Practice Address - Phone:815-546-6513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-24
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA625801223G0001X
IL019.0296161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice