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General NPI Number Information
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NPI Number | 1538263652
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Entity Type | Organization
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Legal Business Name | MUSSO FAMILY DENTISTRY
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 513 WEST CENTERVILLE RD
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City | GARLAND
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State | TX
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Zip | 75041
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Country | US
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Telephone | 972-840-8477
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Fax | 972-840-0505
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Provider Business Mailing Address
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Address Line | 513 WEST CENTERVILLE RD
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City | GARLAND
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State | TX
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Zip | 75041
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Country | US
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Telephone | 972-840-8477
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Fax | 972-840-0505
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL ALLEN MUSSO
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Credential | DDS
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Telephone | 972-840-8477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16290
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 17805
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License Number State | TX
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