Provider Demographics
NPI:1538324512
Name:BUSBEY,, DONALD A III
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:BUSBEY,
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3021
Mailing Address - Country:US
Mailing Address - Phone:217-222-5058
Mailing Address - Fax:
Practice Address - Street 1:124 N 12TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3021
Practice Address - Country:US
Practice Address - Phone:217-222-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-19
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist