Provider Demographics
NPI:1447962097
Name:TUSSING, MARY KATHLEEN (DDS, MS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:TUSSING
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10261 Y ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-4530
Mailing Address - Country:US
Mailing Address - Phone:402-320-0663
Mailing Address - Fax:
Practice Address - Street 1:18009 OAK ST STE A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-6096
Practice Address - Country:US
Practice Address - Phone:402-207-9987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE78771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics