Kimberlly A Bush, D.D.S.
Individual provider Active NPI Dentist · Kearney, NE
NPI 1760699797 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1760699797
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5424 (NE)
- Practice address
- 4112 6TH Ave
Kearney, NE 68845-3395 - Phone
- (308) 236-9694
- NPI assigned
- May 17, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5424 | NE | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bush Dentistry LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5424 | NE | Yes |
Addresses
Primary practice location
4112 6TH Ave
Kearney, NE 68845-3395
Mailing address
4112 6TH Ave
Kearney, NE 68845-3395
Phone (308) 236-9694
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47-0696645-12 | Medicaid | NE |
Other providers in Kearney, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.