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NPI Code Detail

MEDICARE: MARIA I BUSTAMANTE D.M.D.

MEDICARE: MARIA I BUSTAMANTE D.M.D.
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
11223G0001XGeneral Practice Dentistry8198OH

General Provider Information

NPI Number : 1265487409
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA I BUSTAMANTE D.M.D.
Provider Business Mailing Address
First Line : 969 PARADROME ST
Second Line : #101
City : CINCINNATI
State : OH
Zip : 45202-6020
Country : US
Telephone Number : 513-621-0783
Fax Number :
Provider Business Practice Location Address
First Line : 121 E MCMILLAN ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-2606
Country : US
Telephone Number : 513-721-2444
Fax Number : 513-721-2398
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 07/08/2007

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Directions to “ MARIA I BUSTAMANTE D.M.D.” Practice Location

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