Organization
CLARENCE E. BUSH, D.M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARENCE EDWARD BUSH D.M.D. (PRESIDENT)
(229) 246-9986
Entity
Organization
Contact information
Practice address
144 WHIGHAM DAIRY RD, BAINBRIDGE, GA 39817-7833
(229) 246-9986
(229) 246-7492
Mailing address
144 WHIGHAM DAIRY RD, P.O. BOX 878, BAINBRIDGE, GA 39817-7833
(229) 246-9986
(229) 246-7492
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
011667
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00824601A
—
GA
Enumeration date
04/26/2012
Last updated
04/26/2012
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