Healthcare Provider Details

I. General information

NPI: 1003819756
Provider Name (Legal Business Name): JUDY LYNN BUXTON D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 S BRYN MAWR AVE STE 203
BRYN MAWR PA
19010-2133
US

IV. Provider business mailing address

414 CLAIREMONT RD
VILLANOVA PA
19085-1706
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-6060
  • Fax: 610-525-3302
Mailing address:
  • Phone: 610-525-6060
  • Fax: 610-525-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS022498-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: