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General NPI Number Information
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NPI Number | 1053457622
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Entity Type | Organization
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Legal Business Name | BUFORD DENTISTRY
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 1879 BUFORD HWY STE 5
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City | BUFORD
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State | GA
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Zip | 30518-3628
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Country | US
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Telephone | 770-945-7186
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Fax | 770-945-1155
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Provider Business Mailing Address
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Address Line | 1879 BUFORD HWY STE 5
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City | BUFORD
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State | GA
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Zip | 30518-3628
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Country | US
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Telephone | 770-945-7186
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Fax | 770-945-1155
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Authorized Official
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Title or Position | OWNER
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Name | JAMA DENISE EVANS
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Credential | D.M.D
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Telephone | 770-945-7186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10445
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License Number State | GA
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