Provider Demographics
NPI:1841274149
Name:MUSE, DWEEN (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:DWEEN
Middle Name:
Last Name:MUSE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-3829
Mailing Address - Country:US
Mailing Address - Phone:601-684-2814
Mailing Address - Fax:601-684-8540
Practice Address - Street 1:1121 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3829
Practice Address - Country:US
Practice Address - Phone:601-684-2814
Practice Address - Fax:601-684-8540
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOR-172-901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060422Medicaid