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General NPI Number Information
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NPI Number | 1154600013
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Entity Type | Organization
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Legal Business Name | MARK J. BUCHWALDER D.D.S., L.L.C.
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 1237 N MONROE DR SUITE 103
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City | XENIA
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State | OH
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Zip | 45385-6609
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Country | US
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Telephone | 937-376-2441
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Fax |
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Provider Business Mailing Address
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Address Line | 1237 N MONROE DR SUITE 103
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City | XENIA
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State | OH
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Zip | 45385-6609
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Country | US
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Telephone | 937-376-2441
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MARK J BUCHWALDER
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Credential | D.D.S.
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Telephone | 937-479-6098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | OH30018199
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License Number State | OH
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