Healthcare Provider Details

I. General information

NPI: 1972799633
Provider Name (Legal Business Name): WILLIAM BUSSEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 VIKING DR SUITE #215
VIRGINIA BEACH VA
23452-7349
US

IV. Provider business mailing address

477 VIKING DR SUITE #215
VIRGINIA BEACH VA
23452-7349
US

V. Phone/Fax

Practice location:
  • Phone: 757-486-5155
  • Fax: 757-486-4826
Mailing address:
  • Phone: 757-486-5155
  • Fax: 757-486-4826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4066
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: