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General NPI Number Information
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NPI Number | 1326471632
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Entity Type | Organization
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Legal Business Name | Q.B. P.L.L.C.
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Dates
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Enumeration Date | 08/11/2013
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 1601 E DEBBIE LN SUITE 1125
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City | MANSFIELD
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State | TX
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Zip | 76063-3665
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Country | US
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Telephone | 817-405-2253
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 E DEBBIE LN SUITE 1125
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City | MANSFIELD
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State | TX
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Zip | 76063-3665
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Country | US
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Telephone | 817-405-2253
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JEFFREY THOMAS BUSKE
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Credential | D.D.S.
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Telephone | 817-405-2253
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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 | 18992
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License Number State | TX
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