Healthcare Provider Details

I. General information

NPI: 1578910634
Provider Name (Legal Business Name): KELLY LYNN EMERY BUECHNER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 BROADWAY STE D
GROVE CITY OH
43123-3065
US

IV. Provider business mailing address

4104 BROADWAY STE D
GROVE CITY OH
43123-3065
US

V. Phone/Fax

Practice location:
  • Phone: 614-871-0088
  • Fax: 614-871-0088
Mailing address:
  • Phone: 614-871-0088
  • Fax: 614-871-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number24709
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: