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General NPI Number Information
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NPI Number | 1548534415
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Entity Type | Organization
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Legal Business Name | BUSHEY ORAL AND MAXILLOFACIAL SURGERY, INC.
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 7081 WEST BLVD. SUITE 1
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City | YOUNGSTOWN
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State | OH
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Zip | 44512
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Country | US
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Telephone | 330-758-0561
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Fax |
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Provider Business Mailing Address
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Address Line | 7081 WEST BLVD. SUITE 1
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City | YOUNGSTOWN
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State | OH
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Zip | 44512
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Country | US
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Telephone | 330-758-0561
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DR. MICHAEL EDMOND BUSHEY
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Credential | D.D.S.
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Telephone | 330-758-0561
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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 | 14271
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | OH
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