Healthcare Provider Details

I. General information

NPI: 1689798944
Provider Name (Legal Business Name): HELEN D BUSH DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800-A COORS BLVD. NW
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

2800-A COORS BLVD. NW
ALBUQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 505-352-1166
  • Fax: 717-697-7584
Mailing address:
  • Phone: 505-352-1166
  • Fax: 717-697-7584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS028527L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: