Provider Demographics
NPI:1841348554
Name:BUSSIERE, JAMES WALTER (DMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WALTER
Last Name:BUSSIERE
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 752
Mailing Address - Street 2:20 LIBERTY DR
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248
Mailing Address - Country:US
Mailing Address - Phone:860-228-7878
Mailing Address - Fax:860-228-4488
Practice Address - Street 1:20 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248
Practice Address - Country:US
Practice Address - Phone:860-228-7878
Practice Address - Fax:860-228-4488
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077531223P0300X
CT77531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0300XDental ProvidersDentistPeriodontics