Provider Demographics
NPI:1346352010
Name:BUSH, DOUGLAS J (DMD)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:J
Last Name:BUSH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 ROUTE 24
Mailing Address - Street 2:STE 2A
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930
Mailing Address - Country:US
Mailing Address - Phone:908-879-6099
Mailing Address - Fax:908-879-6944
Practice Address - Street 1:385 ROUTE 24
Practice Address - Street 2:STE 2A
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930
Practice Address - Country:US
Practice Address - Phone:908-879-6099
Practice Address - Fax:908-879-6944
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD13138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist