Provider Demographics
NPI:1144337981
Name:BUSCH, EDWARD B (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:B
Last Name:BUSCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10170 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2542
Mailing Address - Country:US
Mailing Address - Phone:727-395-9330
Mailing Address - Fax:727-395-9115
Practice Address - Street 1:10170 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2542
Practice Address - Country:US
Practice Address - Phone:727-395-9330
Practice Address - Fax:727-395-9115
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14832332B00000X
FLDN148321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies