Provider Demographics
NPI:1265573885
Name:BUSCH, PAUL STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEPHEN
Last Name:BUSCH
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 1:3048 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2956
Mailing Address - Country:US
Mailing Address - Phone:269-381-3890
Mailing Address - Fax:269-381-9743
Practice Address - Street 1:3048 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2956
Practice Address - Country:US
Practice Address - Phone:269-381-3890
Practice Address - Fax:269-381-9743
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI85581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice