Individual
DR. ROBERT JOHN BUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MD
Contact information
Practice address
2807 N KNOXVILLE AVE, PEORIA, IL 61604-2869
(309) 682-1213
(309) 682-1213
Mailing address
2807 N KNOXVILLE AVE, PEORIA, IL 61604-2869
(309) 682-1213
(309) 682-1213
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0021934
TX
390200000X
Student in an Organized Health Care Education/Training Program
BP10028831
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467669762
BLUE CROSS BLUE SHIELD
TX
05
—
177585009
—
TX
05
—
177585010
—
TX
01
—
21934
TX DENTAL
TX
01
—
BP10028831
PHYSICIAN IN TRAINING
TX
Enumeration date
05/17/2007
Last updated
08/12/2015
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