Provider Demographics
NPI:1265598213
Name:JAMES R. MUSSER, DDS, INC.
Entity type:Organization
Organization Name:JAMES R. MUSSER, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-965-3077
Mailing Address - Street 1:10425 FAIR OAKS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7559
Mailing Address - Country:US
Mailing Address - Phone:916-965-3077
Mailing Address - Fax:916-965-3079
Practice Address - Street 1:10425 FAIR OAKS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7559
Practice Address - Country:US
Practice Address - Phone:916-965-3077
Practice Address - Fax:916-965-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA214871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty