1982885638 NPI number — DR. ELIZABETH CORINNE BUCKLEY DDS

Table of content: DR. ELIZABETH CORINNE BUCKLEY DDS (NPI 1982885638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982885638 NPI number — DR. ELIZABETH CORINNE BUCKLEY DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCKLEY
Provider First Name:
ELIZABETH
Provider Middle Name:
CORINNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELFARE
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
CORINNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982885638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
359 FRONT ST
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
BEREA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-234-2813
Provider Business Mailing Address Fax Number:
440-234-7820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
359 FRONT ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
BEREA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-234-2813
Provider Business Practice Location Address Fax Number:
440-234-7820
Provider Enumeration Date:
11/23/2007

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: 1223G0001X , with the licence number:  30022612 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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