Healthcare Provider Details

I. General information

NPI: 1164363792
Provider Name (Legal Business Name): LAUREN JAE BUSCHUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DR 10 MDG
USAF ACADEMY CO
80840
US

IV. Provider business mailing address

4102 PINION DR 10 MDG
USAF ACADEMY CO
80840
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32017
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: