MEDICARE: BUECKER & LONG PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1124137823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUECKER & LONG PSC

Provider Business Mailing Address
First Line	:	1100 WASHINGTON STREET
Second Line	:
City	:	SHELLBYVILLE
State	:	KY
Zip	:	40065-1462
Country	:	US
Telephone Number	:	502-633-1915
Fax Number	:	502-633-1098

Provider Business Practice Location Address
First Line	:	1100 WASHINGTON STREET
Second Line	:
City	:	SHELLBYVILLE
State	:	KY
Zip	:	40065-1462
Country	:	US
Telephone Number	:	502-633-1915
Fax Number	:	502-633-1098

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. GERARD LOUIS BUECKER
Credential	:	DMD
Telephone Number	:	502-633-1915

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/22/2020

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