Provider Demographics
NPI:1124047154
Name:BUSH, MARTIN K (DDS)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:K
Last Name:BUSH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ALGER STREET
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220
Mailing Address - Country:US
Mailing Address - Phone:413-743-2524
Mailing Address - Fax:413-749-0145
Practice Address - Street 1:9 PARK STREET
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220
Practice Address - Country:US
Practice Address - Phone:413-743-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice