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General NPI Number Information
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NPI Number | 1689897696
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Entity Type | Organization
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Legal Business Name | DR. CHAD A. BUSH, D.M.D., P.C.
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 919 US HIGHWAY 19 S
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City | LEESBURG
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State | GA
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Zip | 31763-4880
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Country | US
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Telephone | 229-888-3550
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Fax | 229-888-0055
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Provider Business Mailing Address
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Address Line | 919 US HIGHWAY 19 S PO BOX 681
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City | LEESBURG
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State | GA
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Zip | 31763-4880
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Country | US
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Telephone | 229-888-3550
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Fax | 229-888-0055
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHAD BUSH
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Credential | D.M.D.
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Telephone | 229-888-3550
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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 | 11237
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License Number State | GA
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