Provider Demographics
NPI:1851468656
Name:BUSHON, DENNIS EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EDWARD
Last Name:BUSHON
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 1:3515 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5212
Mailing Address - Country:US
Mailing Address - Phone:248-689-2041
Mailing Address - Fax:
Practice Address - Street 1:3515 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5212
Practice Address - Country:US
Practice Address - Phone:248-689-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010095271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
7102000J095270OtherBCBS OF MICHIGAN