Provider Demographics
NPI:1588391759
Name:BUSH, JOSHUA C (DDS)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:C
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 1:925 COUNTY ROAD E E STE 185
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7197
Mailing Address - Country:US
Mailing Address - Phone:651-482-1122
Mailing Address - Fax:
Practice Address - Street 1:925 COUNTY ROAD E E STE 185
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-7197
Practice Address - Country:US
Practice Address - Phone:651-482-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND148201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice