Provider Demographics
NPI:1992069728
Name:BUSHONG, PERRY JOSEPH II (DDS)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:JOSEPH
Last Name:BUSHONG
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4 DOMINION DR BLDG 5-250
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1405
Mailing Address - Country:US
Mailing Address - Phone:210-687-1150
Mailing Address - Fax:210-687-1120
Practice Address - Street 1:4 DOMINION DR BLDG 5-250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1405
Practice Address - Country:US
Practice Address - Phone:210-687-1150
Practice Address - Fax:210-687-1120
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice