Healthcare Provider Details

I. General information

NPI: 1013220599
Provider Name (Legal Business Name): JAN B BUCKSTEIN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S ALBION ST SUITE #718
DENVER CO
80222-4008
US

IV. Provider business mailing address

1660 S ALBION ST SUITE #718
DENVER CO
80222-4008
US

V. Phone/Fax

Practice location:
  • Phone: 303-757-7759
  • Fax: 303-757-1501
Mailing address:
  • Phone: 303-757-7759
  • Fax: 303-757-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number17
License Number StateCO

VIII. Authorized Official

Name: JAN BUCKSTEIN
Title or Position: OWNER
Credential: D.D.S.
Phone: 303-757-7759