Provider Demographics
NPI:1316150295
Name:BHUSHAN, GLORIA E (DDS)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:E
Last Name:BHUSHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GLORIA
Other - Middle Name:E
Other - Last Name:LOPEZ-BHUSHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:500 FLOWER MOUND RD SPC 101
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3414
Mailing Address - Country:US
Mailing Address - Phone:972-539-1995
Mailing Address - Fax:
Practice Address - Street 1:500 FLOWER MOUND RD SPC 101
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3414
Practice Address - Country:US
Practice Address - Phone:972-539-1995
Practice Address - Fax:972-539-1996
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1701468-01Medicaid