Bustleton Dental Care

Primary specialty

DentistTaxonomy code 122300000X

License

DS028963L Issued in PA

Legal business name

BUSTLETON DENTAL CARE

Practice address

11622 Bustleton Ave
Philadelphia, PA 19116-2514

Phone

(267) 538-2627

NPI assigned

Feb 21, 2018

Organization subpart

No

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

Authorized official

Name

Tatyana Mirtaj

Title

Owner

Phone

(267) 538-2627

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Philip Smith, DMD

  • Dentist
  • Conshohocken, PA
  • NPI 1376426676
  NPD (past)

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

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519171200000",
    "number": "1942700463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11622 BUSTLETON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191162514",
            "telephone_number": "267-538-2627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11622 BUSTLETON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191162514",
            "telephone_number": "267-538-2627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUSTLETON DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-21",
        "last_updated": "2018-02-21",
        "status": "A",
        "authorized_official_last_name": "MIRTAJ",
        "authorized_official_first_name": "TATYANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "267-538-2627"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS028963L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek Buss, DO
• Terry Bussard
• Juanita E Bussie, RN
• Molly Bussinger
• Amy M Bustin, PA-C
• Bustleton Healthcare
• Bustleton Mental Health Institute, Inc
• Bustleton Pharmacy
• Bustleton Physical & Sports Rehab
• Elizabeth N Bustos, PHARMD

• Dentist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; 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.