Healthcare Provider Details

I. General information

NPI: 1841376894
Provider Name (Legal Business Name): GERALD JAMES TUSSING DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40TH & HOLDREGE STS.
LLINCOLN NE
68583-0740
US

IV. Provider business mailing address

3741 S 58TH ST
LINCOLN NE
68506-4513
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1286
  • Fax:
Mailing address:
  • Phone: 402-489-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3741
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: