Healthcare Provider Details

I. General information

NPI: 1336679232
Provider Name (Legal Business Name): JEFFREY BUE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6658 AIRPORT HWY
HOLLAND OH
43528-8135
US

IV. Provider business mailing address

245 BROOKRIDGE CT APT 2
ANN ARBOR MI
48103-2904
US

V. Phone/Fax

Practice location:
  • Phone: 567-698-8842
  • Fax:
Mailing address:
  • Phone: 907-328-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.025120
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: