MEDICARE: JOSHUA COUSSA, D.M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1437712999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSHUA COUSSA, D.M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 840925
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4604 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4628
Country	:	US
Telephone Number	:	954-753-6100
Fax Number	:	954-686-0912

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA COUSSA
Credential	:	DMD
Telephone Number	:	972-331-8079

Provider Enumeration Date	:	04/19/2019
Last Update Date	:	10/02/2023

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