Provider Demographics
NPI:1649806415
Name:DR. HECTOR M BUSH, PC
Entity type:Organization
Organization Name:DR. HECTOR M BUSH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-309-3226
Mailing Address - Street 1:129 GLEN EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253
Mailing Address - Country:US
Mailing Address - Phone:404-309-3226
Mailing Address - Fax:
Practice Address - Street 1:602 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371
Practice Address - Country:US
Practice Address - Phone:253-845-7583
Practice Address - Fax:253-845-0535
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. HECTOR M BUSH, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty