1427392232 NPI number — MS. LYNDA H BUSDOSH RDH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427392232 NPI number — MS. LYNDA H BUSDOSH RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSDOSH
Provider First Name:
LYNDA
Provider Middle Name:
H
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427392232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1631 WETZEL AVENUE, BLDG 815
Provider Second Line Business Mailing Address:
US ARMY DENTAL ACTIVITY, ATTN: FRAN GERNERT
Provider Business Mailing Address City Name:
FORT CARSON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-526-5537
Provider Business Mailing Address Fax Number:
719-524-2843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLDG 171, 4TH AND INNER LOOP RD
Provider Second Line Business Practice Location Address:
FORT IRWIN DENTAL CLINIC COMMAND
Provider Business Practice Location Address City Name:
FORT IRWIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92310-5076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-380-4990
Provider Business Practice Location Address Fax Number:
760-380-4996
Provider Enumeration Date:
11/16/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  RDH 14692 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)