Provider Demographics
NPI:1992887715
Name:BUSBY, TERESITA SELGA (RDH)
Entity type:Individual
Prefix:MRS
First Name:TERESITA
Middle Name:SELGA
Last Name:BUSBY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 480 BOX 1675
Mailing Address - Street 2:
Mailing Address - City:APO AE
Mailing Address - State:GERMANY
Mailing Address - Zip Code:09128
Mailing Address - Country:DE
Mailing Address - Phone:703-143-8166
Mailing Address - Fax:
Practice Address - Street 1:CMR 480 BOX 1675
Practice Address - Street 2:
Practice Address - City:APO AE
Practice Address - State:GERMANY
Practice Address - Zip Code:09128
Practice Address - Country:DE
Practice Address - Phone:703-143-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH009009124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist