Healthcare Provider Details

I. General information

NPI: 1043339633
Provider Name (Legal Business Name): ROBERT LAWSON BUCKLES D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/09/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 15TH ST SUITE 104
PLANO TX
75093-5803
US

IV. Provider business mailing address

4100 W 15TH ST SUITE 104
PLANO TX
75093-5803
US

V. Phone/Fax

Practice location:
  • Phone: 972-596-0312
  • Fax: 972-867-7041
Mailing address:
  • Phone: 972-596-0312
  • Fax: 972-867-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: