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General NPI Number Information
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NPI Number | 1447962097
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Entity Type | Individual
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Provider Name | MARY KATHLEEN TUSSING DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 18009 OAK ST STE A
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City | OMAHA
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State | NE
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Zip | 68130-6096
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Country | US
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Telephone | 402-207-9987
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Fax |
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Provider Business Mailing Address
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Address Line | 10261 Y ST
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City | OMAHA
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State | NE
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Zip | 68127-4530
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Country | US
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Telephone | 402-320-0663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7877
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License Number State | NE
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