| Doctor Name: | MRS. TERESA BUSHNELL |
| NPI Number: | 1114315678 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | DT33 |
| Business Practice Address: | 1405 Anne St Nw Bemidji, MN - 566015113 |
| Business Phone Number: | 2184449646 |
| Business Fax Number: | 2184449252 |
| Mailing Address: | 282 Juniper Ln Nw, BEMIDJI |
| State: | MN |
| Postal Code: | 566015735 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/06/2015 |
| NPI Last Update Date: | 01/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 125J00000X |
| License Number: | DT33 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dental Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A Dental Therapist is an individual who has completed an accredited or non-accredited dental therapy program and who has been authorized by the relevant state board or a tribal entity to provide services within the scope of their practice under the supervision of a dentist. Functions that may be delegated to the dental therapist vary based on the needs of the dentist, the educational preparation of the dental therapist and state dental practice acts and regulations. |