Provider Demographics
NPI:1285708610
Name:DONALD A. BUSBEY D.D.S. PROF. CORP.
Entity type:Organization
Organization Name:DONALD A. BUSBEY D.D.S. PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUSBEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-222-5058
Mailing Address - Street 1:124 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3021
Mailing Address - Country:US
Mailing Address - Phone:217-222-5058
Mailing Address - Fax:
Practice Address - Street 1:124 N 12TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3021
Practice Address - Country:US
Practice Address - Phone:217-222-5058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-019135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty