Provider Demographics
NPI:1821344607
Name:A.B. DENTAL P.C.
Entity Type:Organization
Organization Name:A.B. DENTAL P.C.
Other - Org Name:ALAMO RANCH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUSHONG
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-538-2772
Mailing Address - Street 1:11345 ALAMO RANCH PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253
Mailing Address - Country:US
Mailing Address - Phone:210-538-2772
Mailing Address - Fax:210-538-2607
Practice Address - Street 1:11345 ALAMO RANCH PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253
Practice Address - Country:US
Practice Address - Phone:210-538-2772
Practice Address - Fax:210-538-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27950261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental