1023166220 NPI number — BUCKNER MARKET PLACE DENTAL, P.A.

Table of content: (NPI 1023166220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023166220 NPI number — BUCKNER MARKET PLACE DENTAL, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUCKNER MARKET PLACE DENTAL, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1023166220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75209-8517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2947 S BUCKNER BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75227-6944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-381-3800
Provider Business Practice Location Address Fax Number:
214-381-4500
Provider Enumeration Date:
01/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAFEL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-420-7000

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 159801301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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