Healthcare Provider Details

I. General information

NPI: 1669043022
Provider Name (Legal Business Name): CHRISTINA NICOLE BUKATA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 08/01/2021
Certification Date: 08/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 NW 40TH TER STE A
GAINESVILLE FL
32606-8148
US

IV. Provider business mailing address

3731 NW 40TH TER STE A
GAINESVILLE FL
32606-8148
US

V. Phone/Fax

Practice location:
  • Phone: 352-562-0863
  • Fax:
Mailing address:
  • Phone: 754-242-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26195
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number26195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: