Provider Demographics
NPI:1447094420
Name:BUSHRA, AHMEDI (DMD)
Entity type:Individual
Prefix:
First Name:AHMEDI
Middle Name:
Last Name:BUSHRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 MONTCLAIR DR APT 6
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-3638
Mailing Address - Country:US
Mailing Address - Phone:773-704-7368
Mailing Address - Fax:
Practice Address - Street 1:8 W BROOKHAVEN RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2337
Practice Address - Country:US
Practice Address - Phone:610-872-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0446901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty