Provider Demographics
NPI:1750413142
Name:BUSSELL, STEVEN J (DMD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:BUSSELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9884 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-3509
Mailing Address - Country:US
Mailing Address - Phone:561-422-1020
Mailing Address - Fax:561-422-1060
Practice Address - Street 1:9884 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3509
Practice Address - Country:US
Practice Address - Phone:561-422-1020
Practice Address - Fax:561-422-1060
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL162881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice