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General NPI Number Information
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NPI Number | 1720476229
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Entity Type | Organization
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Legal Business Name | BRANDY R. BUCKNER, DDS, PC
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 1170 US 1 HWY STE 110
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-9020
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Country | US
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Telephone | 919-452-6458
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Fax |
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Provider Business Mailing Address
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Address Line | 1170 US HWY 1 SUITE100/110
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City | YOUNGSVILLE
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State | NC
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Zip | 27596
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Country | US
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Telephone | 919-452-6458
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. BRANDY RENEE BUCKNER
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Credential | D.D.S.
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Telephone | 919-452-6458
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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 | 8953
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License Number State | NC
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