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General NPI Number Information
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NPI Number | 1689805350
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Entity Type | Individual
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Provider Name | BARNETT BUCKLAM D.D.S
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Gender | Male
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 345 E 24TH ST
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City | NEW YORK
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State | NY
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Zip | 10010-4020
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Country | US
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Telephone | 212-998-9617
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Fax | 212-995-4119
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Provider Business Mailing Address
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Address Line | 176 E 77TH ST 5D
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City | NEW YORK
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State | NY
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Zip | 10075-1908
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Country | US
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Telephone | 212-744-7164
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 024844-1
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License Number State | NY
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