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General NPI Number Information
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NPI Number | 1558033050
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Entity Type | Organization
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Legal Business Name | THE BUCKLEY DENTAL CENTER PC
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Dates
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Enumeration Date | 10/02/2021
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Last Update Date | 10/02/2021
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Provider Practice Location Address
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Address Line | 2325 GLENWOOD AVE SE
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City | ATLANTA
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State | GA
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Zip | 30316-2362
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Country | US
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Telephone | 678-800-8316
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Fax | 678-800-8317
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Provider Business Mailing Address
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Address Line | 4807 WIGLEY RD NE
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City | MARIETTA
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State | GA
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Zip | 30066-1503
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Country | US
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Telephone | 678-524-7364
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELISHA ELISHA BUCKLEY
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Credential |
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Telephone | 678-524-7364
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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 |
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License Number State |
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