Organization
BUSH PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL WAYNE BUSH DMD (DENTIST/OWNER)
(334) 504-0142
Entity
Organization
Contact information
Practice address
4740 WOODMERE BLVD, MONTGOMERY, AL 36106-3065
(334) 676-2144
(334) 676-2148
Mailing address
3420 LANSDOWNE DR, MONTGOMERY, AL 36111-2115
(334) 504-0142
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6240
AL
Other
Enumeration date
05/31/2017
Last updated
05/31/2017
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