Healthcare Provider Details

I. General information

NPI: 1841348554
Provider Name (Legal Business Name): JAMES WALTER BUSSIERE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LIBERTY DR
HEBRON CT
06248
US

IV. Provider business mailing address

PO BOX 752 20 LIBERTY DR
HEBRON CT
06248
US

V. Phone/Fax

Practice location:
  • Phone: 860-228-7878
  • Fax: 860-228-4488
Mailing address:
  • Phone: 860-228-7878
  • Fax: 860-228-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number007753
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7753
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: