MEDICARE: DR. JEFFREY BUSCH D.D.S.

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	14284	TX

General Provider Information

NPI Number	:	1043389919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY BUSCH D.D.S.

Provider Business Mailing Address
First Line	:	9660 HILLCROFT ST STE 340
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-3866
Country	:	US
Telephone Number	:	713-728-9333
Fax Number	:	713-726-0620

Provider Business Practice Location Address
First Line	:	9660 HILLCROFT ST
Second Line	:	STE 340
City	:	HOUSTON
State	:	TX
Zip	:	77096-3856
Country	:	US
Telephone Number	:	713-728-9333
Fax Number	:	713-726-0620

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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