MEDICARE: DR. ROBERT TIMOTHY BUSEY 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	122300000X	Dentist	5002	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	902H7	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1205944766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT TIMOTHY BUSEY DDS

Provider Business Mailing Address
First Line	:	12 OLD FORT RD
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-9758
Country	:	US
Telephone Number	:	828-628-3504
Fax Number	:	828-628-3505

Provider Business Practice Location Address
First Line	:	12 OLD FORT RD
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-9758
Country	:	US
Telephone Number	:	828-628-3504
Fax Number	:	828-628-3505

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

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	07/08/2007

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