Healthcare Provider Details

I. General information

NPI: 1891781894
Provider Name (Legal Business Name): TIFFANY LYNNE BULLER-SCHUSSLER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2005
Last Update Date: 03/04/2023
Certification Date: 03/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 STATE ROUTE 725 SUITE C
BELLBROOK OH
45305
US

IV. Provider business mailing address

TIFFANY L. BULLER-SCHUSSLER DDS LLC DBA BELLBROOK DENTA 4403 STATE ROUTE 725, SUITE C
BELLBROOK OH
45305
US

V. Phone/Fax

Practice location:
  • Phone: 937-848-8662
  • Fax: 937-848-2317
Mailing address:
  • Phone: 937-848-8662
  • Fax: 937-848-2317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12010111A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5541
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-22095
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8558
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.022095
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: