Provider Demographics
NPI:1043200124
Name:BUSH, BYRON VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:VICTOR
Last Name:BUSH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:BYRON
Other - Middle Name:VICTOR
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2908 SIDCO DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3759
Mailing Address - Country:US
Mailing Address - Phone:615-401-1103
Mailing Address - Fax:615-678-4381
Practice Address - Street 1:2908 SIDCO DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3759
Practice Address - Country:US
Practice Address - Phone:615-401-1103
Practice Address - Fax:615-678-4381
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS31341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN27-4086301OtherTAX ID