MEDICARE: DR. TODD SCOTT BUSDIECKER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30020474	OH

General Provider Information

NPI Number	:	1003896473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD SCOTT BUSDIECKER DDS

Provider Business Mailing Address
First Line	:	4874 WUNNENBERG WAY
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4863
Country	:	US
Telephone Number	:	513-860-1940
Fax Number	:	513-590-1995

Provider Business Practice Location Address
First Line	:	4874 WUNNENBERG WAY
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4863
Country	:	US
Telephone Number	:	513-860-1940
Fax Number	:	513-590-1995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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