Provider Demographics
NPI:1538142237
Name:BUSH, FRANCIS MARION JR
Entity Type:Individual
Prefix:MR
First Name:FRANCIS
Middle Name:MARION
Last Name:BUSH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:FRANCIS
Other - Middle Name:MARION
Other - Last Name:BUSH
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:13411 TORRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-3873
Mailing Address - Country:US
Mailing Address - Phone:804-794-5256
Mailing Address - Fax:
Practice Address - Street 1:1680 HUGUENOT RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2427
Practice Address - Country:US
Practice Address - Phone:804-379-7120
Practice Address - Fax:804-379-9835
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010050921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190000592Medicare ID - Type UnspecifiedPROVIDER NUMBER