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General NPI Number Information
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NPI Number | 1801820725
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Entity Type | Individual
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Provider Name | JEAN HELEN BUSH
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/27/2007
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Provider Practice Location Address
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Address Line | 2001 E LOHMAN, STE 121
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City | LAS CRUCES
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State | NM
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Zip | 88001
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Country | US
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Telephone | 505-526-4334
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Fax | 505-526-7863
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Provider Business Mailing Address
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Address Line | 2001 E LOHMAN, STE 121
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City | LAS CRUCES
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State | NM
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Zip | 88001
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Country | US
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Telephone | 505-526-4334
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Fax | 505-526-7863
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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 | 42561
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD2901
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License Number State | NM
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