Provider Demographics
NPI:1326471632
Name:Q.B. P.L.L.C.
Entity Type:Organization
Organization Name:Q.B. P.L.L.C.
Other - Org Name:MANSFIELD DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BUSKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-405-2253
Mailing Address - Street 1:1601 E DEBBIE LN
Mailing Address - Street 2:SUITE 1125
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3665
Mailing Address - Country:US
Mailing Address - Phone:817-405-2253
Mailing Address - Fax:
Practice Address - Street 1:1601 E DEBBIE LN
Practice Address - Street 2:SUITE 1125
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3665
Practice Address - Country:US
Practice Address - Phone:817-405-2253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-11
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty