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General NPI Number Information
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NPI Number | 1750977914
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Entity Type | Organization
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Legal Business Name | BUSHONG DENTAL, PLLC
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 4 DOMINION DR # 250
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1390
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Country | US
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Telephone | 210-687-1150
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Fax |
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Provider Business Mailing Address
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Address Line | 14806 CIRCLE J TRL
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City | HELOTES
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State | TX
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Zip | 78023-3829
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Country | US
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Telephone | 817-851-3291
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PERRY J BUSHONG II
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Credential | DDS
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Telephone | 817-851-3291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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