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General NPI Number Information
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NPI Number | 1124694252
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Entity Type | Individual
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Provider Name | ANDREW STEPHEN BUCKNER
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Gender | Male
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Dates
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Enumeration Date | 05/30/2021
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Last Update Date | 05/30/2021
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Provider Practice Location Address
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Address Line | 1508 NE 96TH ST STE A
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City | LIBERTY
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State | MO
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Zip | 64068-1396
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Country | US
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Telephone | 816-415-5808
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Fax | 816-415-8083
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Provider Business Mailing Address
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Address Line | 6900 N AMES AVE APT E
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City | KANSAS CITY
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State | MO
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Zip | 64151-4859
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Country | US
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Telephone | 417-214-5848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2021019497
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License Number State | MO
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