MEDICARE: KARL R HUSSEY DMD

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	122300000X	Dentist	12578	MO

General Provider Information

NPI Number	:	1033100789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARL R HUSSEY DMD

Provider Business Mailing Address
First Line	:	4169 N HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2825
Country	:	US
Telephone Number	:	314-653-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4169 N HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2825
Country	:	US
Telephone Number	:	314-653-1200
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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