Healthcare Provider Details

I. General information

NPI: 1316080385
Provider Name (Legal Business Name): KIMBERLY ANNE BUCKNER D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 J F GREEN ST
SANDY HOOK KY
41171-7134
US

IV. Provider business mailing address

P.O. BOX 85
SANDY HOOK KY
41171
US

V. Phone/Fax

Practice location:
  • Phone: 606-738-5545
  • Fax:
Mailing address:
  • Phone: 606-495-5245
  • Fax: 606-738-5405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7741
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7741
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: