MEDICARE: BUSH FAMILY MOBILE DENTISTRY, P.C.

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	1223G0001X	General Practice Dentistry	DS8236	TN

General Provider Information

NPI Number	:	1881729846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUSH FAMILY MOBILE DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	911 MEADOWLARK LN
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-2309
Country	:	US
Telephone Number	:	615-851-6800
Fax Number	:	615-851-0392

Provider Business Practice Location Address
First Line	:	911 MEADOWLARK LN
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-2309
Country	:	US
Telephone Number	:	615-851-6800
Fax Number	:	615-851-0392

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES ALLEN BUSH
Credential	:	DDS
Telephone Number	:	615-851-6800

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/22/2020

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