Provider Demographics
NPI:1598914475
Name:BUSHEY, ANDREW W (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:W
Last Name:BUSHEY
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7081 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4362
Mailing Address - Country:US
Mailing Address - Phone:330-758-0561
Mailing Address - Fax:330-726-4947
Practice Address - Street 1:7081 WEST BLVD STE 1
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4362
Practice Address - Country:US
Practice Address - Phone:330-758-0561
Practice Address - Fax:330-726-4947
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0229661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0087859Medicaid
OHH222530Medicare PIN