Provider Demographics
NPI:1538355011
Name:BUSSEY, KELLY LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LEIGH
Last Name:BUSSEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 VIKING DR
Mailing Address - Street 2:SUTIE #215
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7349
Mailing Address - Country:US
Mailing Address - Phone:757-486-5428
Mailing Address - Fax:757-486-4826
Practice Address - Street 1:477 VIKING DR
Practice Address - Street 2:SUTIE #215
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7349
Practice Address - Country:US
Practice Address - Phone:757-486-5428
Practice Address - Fax:757-486-4826
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014100521223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics