Basic Information
| Provider Information | |||||||||
| NPI: | 1326271610 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUSSEY | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | USA DENTAC BAVARIA | ||||||||
| Address2: | UNIT 28038, CMR 411 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0114963719 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 38TH STREET BLDG 38717 | ||||||||
| Address2: | USA DENTAC ATTN: B. SLOAN | ||||||||
| City: | FORT GORDON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309055660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067876927 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2009 | ||||||||
| LastUpdateDate: | 09/28/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | 10458666-9921 | UT | N | Dental Providers | Dentist | Periodontics | 122300000X | 58586 | CA | Y | Dental Providers | Dentist |
No ID Information.