Provider Demographics
NPI:1780180588
Name:MARTIN K BUSH DDS FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:MARTIN K BUSH DDS FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-743-7220
Mailing Address - Street 1:9 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-2011
Mailing Address - Country:US
Mailing Address - Phone:413-743-7220
Mailing Address - Fax:413-749-0145
Practice Address - Street 1:9 PARK ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-2011
Practice Address - Country:US
Practice Address - Phone:413-743-7220
Practice Address - Fax:413-749-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty