Individual provider Active NPI

Krystin Bussiere, DDS

  • General Practice Dentistry
  • Yakima, WA
National Provider Identifier
1124759964
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE60314890 Issued in WA
Practice address
12 S 8TH St
Yakima, WA 98901-3020
Phone
(509) 454-4143
NPI assigned
Jun 22, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE60314890 WA Primary

Addresses

Primary practice location

12 S 8TH St
Yakima, WA 98901-3020

Mailing address

PO Box 2605
Yakima, WA 98907-2605
Phone (509) 454-4143

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220826000488 WA Order and Referring Only - DentistPractitioner - Dentist 0345624268

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DE60314890WAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Yakima Neighborhood Health Services Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1655856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1124759964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2605",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989072605",
            "telephone_number": "509-454-4143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 S 8TH ST",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989013020",
            "telephone_number": "509-454-4143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSSIERE",
        "first_name": "KRYSTIN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-22",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60314890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

Verify at the official NPI Registry.