Provider Demographics
NPI:1750556866
Name:MUSHOVIC, JAMES (DMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MUSHOVIC
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:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:UNALASKA
Mailing Address - State:AK
Mailing Address - Zip Code:99685-1010
Mailing Address - Country:US
Mailing Address - Phone:907-581-3122
Mailing Address - Fax:
Practice Address - Street 1:159 RIVERSIDE AVE
Practice Address - Street 2:BOX 1010
Practice Address - City:UNALASKA
Practice Address - State:AK
Practice Address - Zip Code:99685
Practice Address - Country:US
Practice Address - Phone:907-581-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47964122300000X
AKAA512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist