Provider Demographics
NPI:1598755472
Name:BUSHELL, ADAM ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ROSS
Last Name:BUSHELL
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:3473 W SOUTH JORDAN PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-6016
Mailing Address - Country:US
Mailing Address - Phone:801-446-2080
Mailing Address - Fax:801-446-2757
Practice Address - Street 1:3473 W SOUTH JORDAN PKWY STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-6016
Practice Address - Country:US
Practice Address - Phone:801-446-2080
Practice Address - Fax:801-446-2757
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT8548529-99231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN