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General NPI Number Information
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NPI Number | 1669609939
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Entity Type | Individual
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Provider Name | STEPHEN DALE BUCKLEW D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 1100 GUM BRANCH RD
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5743
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Country | US
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Telephone | 910-347-2051
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Fax | 910-347-7652
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Provider Business Mailing Address
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Address Line | 1100 GUM BRANCH RD
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5743
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Country | US
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Telephone | 910-347-2051
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Fax | 910-347-7652
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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 | 4882
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License Number State | NC
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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 | 2505
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License Number State | WV
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