Provider Demographics
NPI:1043389919
Name:BUSCH, JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:BUSCH
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 1:9660 HILLCROFT ST STE 340
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-3866
Mailing Address - Country:US
Mailing Address - Phone:713-728-9333
Mailing Address - Fax:713-726-0620
Practice Address - Street 1:9660 HILLCROFT ST
Practice Address - Street 2:STE 340
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-3856
Practice Address - Country:US
Practice Address - Phone:713-728-9333
Practice Address - Fax:713-726-0620
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice