Provider Demographics
NPI:1932666922
Name:ROBERT BUSAN DDS, PLLC
Entity Type:Organization
Organization Name:ROBERT BUSAN DDS, PLLC
Other - Org Name:ADVANCED PERIODONTICS AND IMPLANT SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOGDAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BUSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-285-3147
Mailing Address - Street 1:4035 MORSAY DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4875
Mailing Address - Country:US
Mailing Address - Phone:815-398-1376
Mailing Address - Fax:
Practice Address - Street 1:4035 MORSAY DR STE 1
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4875
Practice Address - Country:US
Practice Address - Phone:815-398-1376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental