Healthcare Provider Details

I. General information

NPI: 1720959950
Provider Name (Legal Business Name): DR. CAROLINE VIOLA BUSCH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 LONGWOOD AVE
BOSTON MA
02115-5888
US

IV. Provider business mailing address

85 PRESCOTT ST APT 38
CAMBRIDGE MA
02138-4360
US

V. Phone/Fax

Practice location:
  • Phone: 617-432-1434
  • Fax:
Mailing address:
  • Phone: 617-432-1434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDL101422
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: