Healthcare Provider Details

I. General information

NPI: 1659481554
Provider Name (Legal Business Name): MARK EDWARD BUFALINI DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 PHYSICIANS DR
WILMINGTON NC
28401-7352
US

IV. Provider business mailing address

1305 PHYSICIANS DR
WILMINGTON NC
28401-7352
US

V. Phone/Fax

Practice location:
  • Phone: 910-762-2618
  • Fax: 910-763-5173
Mailing address:
  • Phone: 910-762-2618
  • Fax: 910-763-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2007-00364
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number2007-00364
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2007-00364
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS035576
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: