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Organization

EBENEZER BUSH, A PROFESSIONAL CORPORATION

Active
Other names
Ebenezer Bush, DDS
Organization subpart
No

Provider details

NPI number
Authorized official
DR. EBENEZER BUSH JR. DDS (OWNER)
(310) 638-1122
Entity
Organization

Contact information

Practice address
609 S LONG BEACH BLVD, COMPTON, CA 90221-4026
(310) 638-1122
(310) 638-7565
Mailing address
609 S LONG BEACH BLVD, COMPTON, CA 90221-4026
(310) 638-1122
(310) 638-7565

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12355
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
B1235501
CA
Enumeration date
11/19/2008
Last updated
11/19/2008
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