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General NPI Number Information
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NPI Number | 1154578698
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Entity Type | Organization
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Legal Business Name | DR WALTER B BUSSE &ASSOCIATES LTD
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 536 E 162ND ST
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2326
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Country | US
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Telephone | 708-331-2322
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Fax |
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Provider Business Mailing Address
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Address Line | 536 E 162ND ST
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2326
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Country | US
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Telephone | 708-331-2322
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WALTER BERGE BUSSE
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Credential | DDS
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Telephone | 708-331-2322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 019014809
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License Number State | IL
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