Healthcare Provider Details

I. General information

NPI: 1386802494
Provider Name (Legal Business Name): TIFFANY L. BULLER-SCHUSSLER, DDS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2008
Last Update Date: 05/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N BEND RD SUITE A
HEBRON KY
41048-9125
US

IV. Provider business mailing address

1960 N BEND RD SUITE A
HEBRON KY
41048-9125
US

V. Phone/Fax

Practice location:
  • Phone: 859-653-0525
  • Fax: 859-689-1140
Mailing address:
  • Phone: 859-653-0525
  • Fax: 859-689-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number8558
License Number StateKY

VIII. Authorized Official

Name: DR. TIFFANY LYNNE BULLER-SCHUSSLER
Title or Position: DENTIST/PRESIDENT
Credential: DDS
Phone: 859-653-0525