Provider Demographics
NPI:1821173717
Name:BUSHINGER, PHILLIP (DMD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:BUSHINGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GREENSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2709
Mailing Address - Country:US
Mailing Address - Phone:908-757-7991
Mailing Address - Fax:
Practice Address - Street 1:346 SOUTH AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1373
Practice Address - Country:US
Practice Address - Phone:908-889-9300
Practice Address - Fax:908-889-9308
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101297900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist