Healthcare Provider Details

I. General information

NPI: 1518980929
Provider Name (Legal Business Name): DEBORAH ANNE BUZZARD D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 LIME KILN LN SUITE E
LOUISVILLE KY
40222-3429
US

IV. Provider business mailing address

2415 LIME KILN LN SUITE E
LOUISVILLE KY
40222-3429
US

V. Phone/Fax

Practice location:
  • Phone: 502-426-6089
  • Fax: 502-339-0312
Mailing address:
  • Phone: 502-426-6089
  • Fax: 502-339-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5855
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5918
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: