Healthcare Provider Details

I. General information

NPI: 1659698082
Provider Name (Legal Business Name): EDGAR LEROY BUEHLER JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2010
Last Update Date: 04/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 5TH AVE SUITE 1865
NEW YORK NY
10111-0100
US

IV. Provider business mailing address

630 5TH AVE SUITE 1865
NEW YORK NY
10111-0100
US

V. Phone/Fax

Practice location:
  • Phone: 212-581-8892
  • Fax: 212-399-5647
Mailing address:
  • Phone: 212-581-8892
  • Fax: 212-399-5647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number021803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: