Healthcare Provider Details

I. General information

NPI: 1316922164
Provider Name (Legal Business Name): RICHARD ALLEN BUCK D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S 2ND AVE
WALLA WALLA WA
99362-3002
US

IV. Provider business mailing address

217 S 2ND AVE
WALLA WALLA WA
99362-3002
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-7250
  • Fax:
Mailing address:
  • Phone: 509-525-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number11779981
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7575
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61545909
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: