Provider Demographics
NPI:1104025667
Name:BUSCH, DIANNE M (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:M
Last Name:BUSCH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7733 W NEWBERRY RD
Mailing Address - Street 2:SUITE B3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-9245
Mailing Address - Country:US
Mailing Address - Phone:352-331-4700
Mailing Address - Fax:352-331-4743
Practice Address - Street 1:7733 W NEWBERRY RD
Practice Address - Street 2:SUITE B3
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-9245
Practice Address - Country:US
Practice Address - Phone:352-331-4700
Practice Address - Fax:352-331-4743
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021012L122300000X
FLDN165281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist