Provider Demographics
NPI:1144395930
Name:BUSH, JONN C (DDS)
Entity Type:Individual
Prefix:
First Name:JONN
Middle Name:C
Last Name:BUSH
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 1:11333 N DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98020-6118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11301 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6152
Practice Address - Country:US
Practice Address - Phone:206-367-2011
Practice Address - Fax:206-367-2050
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA53961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice