Organization
FOUR SEASONS DENTAL ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS E BUSHON DDS (MEMBER)
(231) 839-4673
Entity
Organization
Contact information
Practice address
301 MAIN ST, LAKE CITY, MI 49651-0589
(231) 839-4673
(231) 839-7874
Mailing address
PO BOX 589, 301 MAIN ST, LAKE CITY, MI 49651-0589
(231) 839-4673
(231) 839-7874
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8011320
BCBS OF MICHIGAN
—
Enumeration date
11/29/2006
Last updated
08/22/2020
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