Organization
OLD OAKS DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AARON BUSHONG DDS (OWNER)
(715) 573-3868
Entity
Organization
Contact information
Practice address
9809 39TH AVE STE 1, PLEASANT PRAIRIE, WI 53158-3733
(715) 573-3868
Mailing address
9809 39TH AVE STE 1, PLEASANT PRAIRIE, WI 53158-3733
(715) 573-3868
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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