Provider Demographics
NPI:1225129265
Name:BUSCH, NORMAN DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:DAVID
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 1:2260 NORTHLAKE PARKWAY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:770-491-1686
Mailing Address - Fax:
Practice Address - Street 1:2260 NORTHLAKE PARKWAY
Practice Address - Street 2:SUITE 211
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:770-491-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist