Active NPI
John Richard Bush, DDS
- Dentist
- Jamestown, RI
National Provider Identifier
1710014063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1553
- Practice address
- 20 Clinton Ave
Jamestown, RI 02835 - Phone
- (401) 423-2110
- Fax
- (401) 423-9224
- NPI assigned
- Feb 27, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1553 | RI | Primary |
Addresses
Primary practice location
20 Clinton Ave
Jamestown, RI 02835
Mailing address
20 Clinton Ave
Jamestown, RI 02835
Phone (401) 423-2110
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| JB04157 | Medicaid | RI | |
| 80356 | Other | BLUE CROSS DENTAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1553 | RI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Dental Associates III, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Jamestown, RI
- NPI 1831587260
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710014063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 CLINTON AVE",
"city": "JAMESTOWN",
"state": "RI",
"postal_code": "02835",
"telephone_number": "401-423-2110",
"fax_number": "401-423-9224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 CLINTON AVE",
"city": "JAMESTOWN",
"state": "RI",
"postal_code": "02835",
"telephone_number": "401-423-2110",
"fax_number": "401-423-9224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSH",
"first_name": "JOHN",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "RI",
"license": "1553",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "JB04157",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS DENTAL",
"identifier": "80356",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamestown, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.