Provider Demographics
NPI:1003896473
Name:BUSDIECKER, TODD SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:SCOTT
Last Name:BUSDIECKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4874 WUNNENBERG WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4863
Mailing Address - Country:US
Mailing Address - Phone:513-860-1940
Mailing Address - Fax:513-590-1995
Practice Address - Street 1:4874 WUNNENBERG WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4863
Practice Address - Country:US
Practice Address - Phone:513-860-1940
Practice Address - Fax:513-590-1995
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300204741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice