Provider Demographics
NPI:1245794643
Name:LUSH DENTAL, PLC
Entity Type:Organization
Organization Name:LUSH DENTAL, PLC
Other - Org Name:DBA LUSH FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LOUSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-303-0909
Mailing Address - Street 1:LUSH FAMILY DENTAL
Mailing Address - Street 2:2505 SE ENCOMPASS DR.
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8099
Mailing Address - Country:US
Mailing Address - Phone:515-303-0909
Mailing Address - Fax:
Practice Address - Street 1:LUSH FAMILY DENTAL
Practice Address - Street 2:2505 SE ENCOMPASS DR.
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8099
Practice Address - Country:US
Practice Address - Phone:515-303-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty