Provider Demographics
NPI:1720114911
Name:CUSSON, LISA ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:CUSSON
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 1:207 STEAMBOAT DR
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-4177
Mailing Address - Country:US
Mailing Address - Phone:781-837-5487
Mailing Address - Fax:
Practice Address - Street 1:72 SUMMER ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3457
Practice Address - Country:US
Practice Address - Phone:508-746-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA295421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice