Provider Demographics
NPI:1386650125
Name:BUSBY, TERRENCE ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:ALLEN
Last Name:BUSBY
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 1:26 S MERRILL ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4219
Mailing Address - Country:US
Mailing Address - Phone:847-696-3493
Mailing Address - Fax:
Practice Address - Street 1:6314 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-3711
Practice Address - Country:US
Practice Address - Phone:773-774-9244
Practice Address - Fax:773-774-1804
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190154031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice