Provider Demographics
NPI:1831106434
Name:BUSO, HANNAH M (DDS)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:M
Last Name:BUSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4277
Mailing Address - Country:US
Mailing Address - Phone:479-452-6600
Mailing Address - Fax:
Practice Address - Street 1:8020 DALLAS ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4277
Practice Address - Country:US
Practice Address - Phone:479-452-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5899122300000X
AR3851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist