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Dr. Robert John Busch, DMDMD
Student in an Organized Health Care Education/Training Program in Peoria, Illinois
NPI 1467669762

Robert John Busch is a Student in an Organized Health Care Education/Training Program based in Peoria, IL. Robert John Busch practices in Peoria, IL and has the professional credentials of DMDMD. The NPI Number for Robert John Busch is 1467669762 and holds a License No. 0021934 (Illinois).

The current practice location address for Robert John Busch is 2807 N Knoxville Ave, Peoria, IL and can be reached out via phone at 309-682-1213 and via fax at 309-682-1213.

Location: 2807 N Knoxville Ave, Peoria, IL, 61604-2869
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1467669762
Provider Name
Robert John Busch
Credential
DMDMD
Provider Entity Type
Individual
Gender
Male
Address
2807 N Knoxville Ave, Peoria, IL, 61604-2869
Phone Number
309-682-1213
Fax Number
309-682-1213
Provider Enumeration Date
05/17/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
177585009 05 TX
1467669762 01 TX BLUE CROSS BLUE SHIELD
177585010 05 TX
21934 01 TX TX DENTAL
BP10028831 01 TX PHYSICIAN IN TRAINING
institution
Provider Business Practice Location Address Details
Address
2807 N Knoxville Ave
City
Peoria
State
Illinois
Zip
61604-2869
Phone Number
309-682-1213
Fax Number
309-682-1213
person
Provider Business Mailing Address Details
Address
2807 N Knoxville Ave
City
Peoria
State
Illinois
Zip
61604-2869
Phone Number
309-682-1213
Fax Number
309-682-1213
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
1223S0112X
License No.
BP10028831 (Texas)
Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
0021934 (Texas)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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