Provider Demographics
NPI:1871813329
Name:BUSHONG, AARON JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:JOHN
Last Name:BUSHONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N 17TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4225
Mailing Address - Country:US
Mailing Address - Phone:715-842-3933
Mailing Address - Fax:715-848-3483
Practice Address - Street 1:301 N 17TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4225
Practice Address - Country:US
Practice Address - Phone:715-842-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6524-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice