MEDICARE: DR. RYAN BUSCH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN124095	GA

General Provider Information

NPI Number	:	1306469101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN BUSCH DMD

Provider Business Mailing Address
First Line	:	1470 LAWRENCEVILLE HWY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-4646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1470 LAWRENCEVILLE HWY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-4646
Country	:	US
Telephone Number	:	--
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	06/11/2026

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