Healthcare Provider Details

I. General information

NPI: 1356447767
Provider Name (Legal Business Name): DAVID E. BUCK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 POLLACK AVE
EVANSVILLE IN
47714-4348
US

IV. Provider business mailing address

2018 POLLACK AVE
EVANSVILLE IN
47714-4348
US

V. Phone/Fax

Practice location:
  • Phone: 812-476-9391
  • Fax: 812-476-0224
Mailing address:
  • Phone: 812-476-9391
  • Fax: 812-476-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12008250A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: