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General NPI Number Information
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NPI Number | 1619469848
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Entity Type | Individual
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Provider Name | MATTHEW LEE BUSWELL DDS
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Gender | Male
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 3407 BERRYWOOD DR STE 200
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City | COLUMBIA
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State | MO
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Zip | 65201-6500
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Country | US
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Telephone | 573-603-1460
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Fax |
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Provider Business Mailing Address
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Address Line | 336 BROOKLYN AVE APT 1
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City | KANSAS CITY
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State | MO
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Zip | 64124-2985
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Country | US
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Telephone | 816-315-7432
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2018017587
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License Number State | MO
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