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General NPI Number Information
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NPI Number | 1962043810
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Entity Type | Organization
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Legal Business Name | EDWARD B. BUSCH, DMD
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 10170 SEMINOLE BLVD
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City | SEMINOLE
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State | FL
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Zip | 33772-2542
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Country | US
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Telephone | 727-395-9330
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Fax | 727-395-9115
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Provider Business Mailing Address
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Address Line | 10170 SEMINOLE BLVD
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City | SEMINOLE
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State | FL
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Zip | 33772-2542
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Country | US
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Telephone | 727-395-9330
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Fax | 727-395-9115
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | EDWARD B BUSCH
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Credential | DMD
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Telephone | 727-395-9330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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