# EBENEZER BUSH, A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ebenezer Bush, DDS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780839639
- **Authorized official:** DR. EBENEZER BUSH JR. DDS (OWNER)
- **Authorized official phone:** (310) 638-1122

## Contact information

- **Practice address:** 609 S LONG BEACH BLVD, COMPTON, CA 90221-4026
- **Practice address phone:** (310) 638-1122
- **Practice address fax:** (310) 638-7565
- **Mailing address:** 609 S LONG BEACH BLVD, COMPTON, CA 90221-4026
- **Mailing address phone:** (310) 638-1122
- **Mailing address fax:** (310) 638-7565

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12355 | CA | Yes |

## Other

- **Enumeration date:** 11/19/2008
- **Last updated:** 11/19/2008