Healthcare Provider Details

I. General information

NPI: 1932239779
Provider Name (Legal Business Name): DENNIS JL BUCHMAN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W BAKER STREET
PLANT CITY FL
33563-4309
US

IV. Provider business mailing address

1205 W BAKER ST
PLANT CITY FL
33563-4309
US

V. Phone/Fax

Practice location:
  • Phone: 813-659-4929
  • Fax: 813-659-4941
Mailing address:
  • Phone: 813-659-4929
  • Fax: 813-659-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN7667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: