Healthcare Provider Details

I. General information

NPI: 1487579843
Provider Name (Legal Business Name): GRACE CATHERINE BUSCH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 INDIANPIPE RD
LAKE ORION MI
48360-2613
US

IV. Provider business mailing address

1131 INDIANPIPE RD
LAKE ORION MI
48360-2613
US

V. Phone/Fax

Practice location:
  • Phone: 248-770-9388
  • Fax:
Mailing address:
  • Phone: 248-770-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603287
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: