Healthcare Provider Details

I. General information

NPI: 1457687089
Provider Name (Legal Business Name): IRAMA LORENA BUSH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORENA BUSH DDS

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S INDEPENDENCE BLVD STE 3
VIRGINIA BEACH VA
23453-4776
US

IV. Provider business mailing address

2020 S INDEPENDENCE BLVD STE 3
VIRGINIA BEACH VA
23453-4776
US

V. Phone/Fax

Practice location:
  • Phone: 757-500-5591
  • Fax:
Mailing address:
  • Phone: 757-500-5591
  • Fax: 757-500-5037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401412668
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: