Provider Demographics
NPI:1730223157
Name:BUSHAY, TERRY WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:WILLIAM
Last Name:BUSHAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK DR
Mailing Address - Street 2:STE D
Mailing Address - City:HOLIDAY ISLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72631-9216
Mailing Address - Country:US
Mailing Address - Phone:479-253-2262
Mailing Address - Fax:479-253-2288
Practice Address - Street 1:1 PARK DR
Practice Address - Street 2:STE D
Practice Address - City:HOLIDAY ISLAND
Practice Address - State:AR
Practice Address - Zip Code:72631-9216
Practice Address - Country:US
Practice Address - Phone:479-253-2262
Practice Address - Fax:479-253-2288
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist