Provider Demographics
NPI:1427392232
Name:BUSDOSH, LYNDA H (RDH)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:H
Last Name:BUSDOSH
Suffix:
Gender:F
Credentials:RDH
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Other - Credentials:
Mailing Address - Street 1:1631 WETZEL AVENUE, BLDG 815
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY, ATTN: FRAN GERNERT
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:719-526-5537
Mailing Address - Fax:719-524-2843
Practice Address - Street 1:BLDG 171, 4TH AND INNER LOOP RD
Practice Address - Street 2:FORT IRWIN DENTAL CLINIC COMMAND
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-5076
Practice Address - Country:US
Practice Address - Phone:760-380-4990
Practice Address - Fax:760-380-4996
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARDH 14692124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist