Provider Demographics
NPI:1689798944
Name:BUSH, HELEN D (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:D
Last Name:BUSH
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800-A COORS BLVD. NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120
Mailing Address - Country:US
Mailing Address - Phone:505-352-1166
Mailing Address - Fax:717-697-7584
Practice Address - Street 1:2800-A COORS BLVD. NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120
Practice Address - Country:US
Practice Address - Phone:505-352-1166
Practice Address - Fax:717-697-7584
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028527L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-1887446OtherTAX ID NUMBER