MEDICARE: DR. KURT B BUSKA 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	DY033912	CA
2	1223G0001X	General Practice Dentistry	1400	VI

General Provider Information

NPI Number	:	1366646770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT B BUSKA D.D.S.

Provider Business Mailing Address
First Line	:	5030 ANCHOR WAY, SUITE 8
Second Line	:	GALLOWS BAY
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4692
Country	:	US
Telephone Number	:	340-719-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 ANCHOR WAY, SUITE 8
Second Line	:	GALLOWS BAY
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4692
Country	:	US
Telephone Number	:	340-719-7000
Fax Number	:

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	10/31/2012

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