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General NPI Number Information
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NPI Number | 1285708610
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Entity Type | Organization
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Legal Business Name | DONALD A. BUSBEY D.D.S. PROF. CORP.
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Dates
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Enumeration Date | 11/18/2006
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Last Update Date | 07/19/2008
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Provider Practice Location Address
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Address Line | 124 N 12TH ST
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City | QUINCY
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State | IL
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Zip | 62301-3021
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Country | US
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Telephone | 217-222-5058
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Fax |
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Provider Business Mailing Address
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Address Line | 124 N 12TH ST
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City | QUINCY
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State | IL
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Zip | 62301-3021
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Country | US
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Telephone | 217-222-5058
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Fax |
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Authorized Official
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Title or Position | PRES.
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Name | DR. DONALD A BUSBEY III
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Credential | D.M.D.
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Telephone | 217-222-5058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-019135
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License Number State | IL
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