Individual
BENJAMIN DAVID BUSHNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
150 BILLS RD, LAKESIDE, MT 59922
(406) 844-3825
(406) 844-3972
Mailing address
PO BOX 302, LAKESIDE, MT 59922
(406) 844-3825
(406) 844-3972
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2127
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0113458
—
MT
Enumeration date
02/05/2007
Last updated
07/08/2007
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