Provider Demographics
NPI:1194902882
Name:BUSK, JANIE LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:JANIE
Middle Name:LYNN
Last Name:BUSK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JANIE
Other - Middle Name:LYNN
Other - Last Name:MARPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1340
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-1340
Mailing Address - Country:US
Mailing Address - Phone:509-422-6705
Mailing Address - Fax:509-422-6708
Practice Address - Street 1:626 SECOND AVE
Practice Address - Street 2:
Practice Address - City:OKANOGAN
Practice Address - State:WA
Practice Address - Zip Code:98840-1340
Practice Address - Country:US
Practice Address - Phone:509-422-6705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5056999Medicaid