Provider Demographics
NPI:1306954839
Name:TANA M BUSCH DDS PLLC
Entity type:Organization
Organization Name:TANA M BUSCH DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-452-8262
Mailing Address - Street 1:8118 SHOAL CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8041
Mailing Address - Country:US
Mailing Address - Phone:512-452-8262
Mailing Address - Fax:512-420-8265
Practice Address - Street 1:8118 SHOAL CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8041
Practice Address - Country:US
Practice Address - Phone:512-452-8262
Practice Address - Fax:512-420-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty