NPIMap

Organization Active NPI

William J Busacca DDS, PS

  • General Practice Dentistry
  • Shelton, WA
National Provider Identifier
1043592397
Registry record updated Sep 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4275 Issued in WA
Legal business name
WILLIAM J BUSACCA DDS, PS
Practice address
1525 Olympic Hwy N
Shelton, WA 98584-3049
Phone
(360) 426-9711
Fax
(360) 426-6361
NPI assigned
Sep 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Leah R Hendrickson
Title
Office Manager
Phone
(360) 426-9711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 4275 WA Primary

Addresses

Primary practice location

1525 Olympic Hwy N
Shelton, WA 98584-3049

Mailing address

1525 Olympic Hwy N
Shelton, WA 98584-3049
Phone (360) 426-9711

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315872000000",
    "number": "1043592397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 OLYMPIC HWY N",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985843049",
            "telephone_number": "360-426-9711",
            "fax_number": "360-426-6361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 OLYMPIC HWY N",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985843049",
            "telephone_number": "360-426-9711",
            "fax_number": "360-426-6361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM J BUSACCA DDS, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-13",
        "last_updated": "2011-09-13",
        "status": "A",
        "authorized_official_last_name": "HENDRICKSON",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "360-426-9711",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "4275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.