Provider Demographics
NPI:1790139913
Name:BUSHMAN DENTAL CARE P.C.
Entity Type:Organization
Organization Name:BUSHMAN DENTAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:BUSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-348-8884
Mailing Address - Street 1:400 E US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2046
Mailing Address - Country:US
Mailing Address - Phone:928-348-8884
Mailing Address - Fax:928-348-8480
Practice Address - Street 1:400 E US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2046
Practice Address - Country:US
Practice Address - Phone:928-348-8884
Practice Address - Fax:928-348-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty