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General NPI Number Information
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NPI Number | 1487919866
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Entity Type | Organization
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Legal Business Name | BUSHNELL FAMILY DENTISTRY
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 525 E WATER ST
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City | BUSHNELL
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State | IL
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Zip | 61422-1764
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Country | US
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Telephone | 309-772-2124
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Fax |
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Provider Business Mailing Address
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Address Line | 525 E WATER ST
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City | BUSHNELL
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State | IL
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Zip | 61422-1764
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Country | US
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Telephone | 309-772-2124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CYNTHIA PAIGE MCCORD
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Credential | DDS
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Telephone | 309-772-2124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 020-010827
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-028904
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License Number State | IL
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