Individual
MS. LISA BUSH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DENTIST
Contact information
Practice address
401 HOLLY HILLS AVE, SAINT LOUIS, MO 63111-2410
(314) 481-1615
(314) 353-1310
Mailing address
401 HOLLY HILLS AVE, SAINT LOUIS, MO 63111-2410
(314) 481-1615
(314) 353-1310
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
015217
MO
Other
Enumeration date
11/29/2005
Last updated
07/08/2007
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