Provider Demographics
NPI:1962043810
Name:EDWARD B. BUSCH, DMD
Entity Type:Organization
Organization Name:EDWARD B. BUSCH, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-395-9330
Mailing Address - Street 1:10170 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2542
Mailing Address - Country:US
Mailing Address - Phone:727-395-9330
Mailing Address - Fax:727-395-9115
Practice Address - Street 1:10170 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2542
Practice Address - Country:US
Practice Address - Phone:727-395-9330
Practice Address - Fax:727-395-9115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWARD B. BUSCH, DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies