Healthcare Provider Details

I. General information

NPI: 1205768488
Provider Name (Legal Business Name): BUSHNELL DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E WATER ST
BUSHNELL IL
61422-1764
US

IV. Provider business mailing address

525 E WATER ST
BUSHNELL IL
61422-1764
US

V. Phone/Fax

Practice location:
  • Phone: 309-772-2124
  • Fax:
Mailing address:
  • Phone: 309-772-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NIHAR N. SHAH
Title or Position: DENTIST
Credential: DMD
Phone: 309-772-2124