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General NPI Number Information
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NPI Number | 1447415849
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Entity Type | Individual
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Provider Name | KENDELL THERON BUXTON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 06/08/2014
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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 | 106 UNDERWOOD CT
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City | FORT COLLINS
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State | CO
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Zip | 80525-4290
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Country | US
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Telephone | 505-609-9544
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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 | NMDD3013
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License Number State | NM
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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 | 30-023673
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License Number State | OH
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Taxonomy #3
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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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