Healthcare Provider Details

I. General information

NPI: 1013848159
Provider Name (Legal Business Name): NICK J BUSH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 GANTZ RD
GROVE CITY OH
43123-4816
US

IV. Provider business mailing address

6699 RAYNOR CT
DUBLIN OH
43017-8073
US

V. Phone/Fax

Practice location:
  • Phone: 614-875-7070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30028502
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: