Ebenezer Bush, a Professional Corporation

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12355 Issued in CA

Legal business name

EBENEZER BUSH, A PROFESSIONAL CORPORATION

Practice address

609 S Long Beach Blvd
Compton, CA 90221-4026

Phone

(310) 638-1122

Fax

(310) 638-7565

NPI assigned

Nov 19, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ebenezer Bush Jr., DDS

Title

Owner

Phone

(310) 638-1122

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ebenezer Bush, DDS Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227052800000",
    "number": "1780839639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 S LONG BEACH BLVD",
            "city": "COMPTON",
            "state": "CA",
            "postal_code": "902214026",
            "telephone_number": "310-638-1122",
            "fax_number": "310-638-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 S LONG BEACH BLVD",
            "city": "COMPTON",
            "state": "CA",
            "postal_code": "902214026",
            "telephone_number": "310-638-1122",
            "fax_number": "310-638-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER BUSH, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-19",
        "last_updated": "2008-11-19",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "EBENEZER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-638-1122",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "12355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B1235501",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ebenezer Bush, DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Compton, CA
• Providers in Compton, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.