Provider Demographics
NPI:1821449273
Name:BUSHMAN, NATHAN E (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:E
Last Name:BUSHMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8197
Mailing Address - Country:US
Mailing Address - Phone:541-281-3938
Mailing Address - Fax:
Practice Address - Street 1:6615 W ARGENT RD
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-1905
Practice Address - Country:US
Practice Address - Phone:509-547-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE606745281223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice