MEDICARE: DR. JAMES WALTER GUSFA 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	1223G0001X	General Practice Dentistry	2901010327	MI

General Provider Information

NPI Number	:	1477551117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES WALTER GUSFA D.,D.S.

Provider Business Mailing Address
First Line	:	24825 MICHIGAN AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1757
Country	:	US
Telephone Number	:	313-565-5350
Fax Number	:	313-565-5561

Provider Business Practice Location Address
First Line	:	24825 MICHIGAN AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1757
Country	:	US
Telephone Number	:	313-565-5350
Fax Number	:	313-565-5561

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

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

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