Healthcare Provider Details

I. General information

NPI: 1982696845
Provider Name (Legal Business Name): KATHLEEN DAWN BUSS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 04/02/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41479 BUSE RD BLDG 1370
PATUXENT RIVER MD
20653
US

IV. Provider business mailing address

3908 BALTIMORE ST
KENSINGTON MD
20895-3906
US

V. Phone/Fax

Practice location:
  • Phone: 301-342-1408
  • Fax:
Mailing address:
  • Phone: 202-730-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number08269
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number08269
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: