Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 10775 | TX |
NPI | 1053457382 |
---|---|
Provider Name | Dr. Harry I Bussa JR. |
First Address | Katy, TX 77494-3603 |
Second Address | Katy, TX 77494-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |