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General NPI Number Information
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NPI Number | 1093125940
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Entity Type | Organization
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Legal Business Name | KENDELL T. BUXTON, DDS, PLLC
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 1331 E PROSPECT RD UNIT B2
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City | FORT COLLINS
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State | CO
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Zip | 80525-1367
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Country | US
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Telephone | 970-482-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 1331 E PROSPECT RD UNIT B2
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City | FORT COLLINS
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State | CO
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Zip | 80525-1367
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Country | US
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Telephone | 970-482-6333
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENDELL THERON BUXTON
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Credential | DDS
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Telephone | 505-609-9544
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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 | 00202193
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License Number State | CO
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