MEDICARE: DR. TAMMY KUSSMAN D.D.S

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	DS7354	TN

General Provider Information

NPI Number	:	1174638357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMMY KUSSMAN D.D.S

Provider Business Mailing Address
First Line	:	783 OLD HICKORY BLVD
Second Line	:	SUITE 305
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4508
Country	:	US
Telephone Number	:	615-346-3007
Fax Number	:	615-346-3005

Provider Business Practice Location Address
First Line	:	783 OLD HICKORY BLVD
Second Line	:	SUITE 305
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4508
Country	:	US
Telephone Number	:	615-346-3007
Fax Number	:	615-346-3005

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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