MEDICARE: JAMES HUSEMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12010876A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12010876A	OTHER	IN	JAMES A. HUSEMAN

General Provider Information

NPI Number	:	1023237963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES HUSEMAN DDS

Provider Business Mailing Address
First Line	:	485 NOBLE CREEK DR
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3108
Country	:	US
Telephone Number	:	131-777-0124
Fax Number	:

Provider Business Practice Location Address
First Line	:	485 NOBLE CREEK DR
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3108
Country	:	US
Telephone Number	:	131-777-0124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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