Provider Demographics
NPI:1851880934
Name:BUSHMAN, RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:BUSHMAN
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 1:919 N PINES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4932
Mailing Address - Country:US
Mailing Address - Phone:509-924-0381
Mailing Address - Fax:
Practice Address - Street 1:919 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206
Practice Address - Country:US
Practice Address - Phone:509-924-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60855064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
153536142OtherAMERICAN DENTAL ASSOCIATION
WA2102572Medicaid
WADE60855064OtherWA STATE DEPARTMENT OF HEALTH