Provider Demographics
NPI:1881759462
Name:BUSH, ANA MARIA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANA MARIA
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24632 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-7307
Mailing Address - Country:US
Mailing Address - Phone:813-948-6335
Mailing Address - Fax:813-948-6394
Practice Address - Street 1:24632 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7307
Practice Address - Country:US
Practice Address - Phone:813-948-6336
Practice Address - Fax:813-948-6394
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14833332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies