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General NPI Number Information
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NPI Number | 1437478914
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Entity Type | Individual
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Provider Name | ANGELA B BUKSTEIN DDS
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Gender | Female
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 86 W 225TH ST
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City | BRONX
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State | NY
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Zip | 10463-7002
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Country | US
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Telephone | 201-308-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 209 W 104TH ST APT 4E
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City | NEW YORK
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State | NY
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Zip | 10025-4235
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Country | US
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Telephone |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 058393-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D12874
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License Number State | MN
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