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General NPI Number Information
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NPI Number | 1730718446
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Entity Type | Individual
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Provider Name | CHRISTIAN LEIGH BUCKNER RDH, BS
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Gender | Female
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Dates
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Enumeration Date | 04/04/2020
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Last Update Date | 04/04/2020
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Provider Practice Location Address
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Address Line | 5014 ROSWELL RD
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City | SANDY SPRINGS
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State | GA
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Zip | 30342-2207
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Country | US
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Telephone | 404-847-9711
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Fax |
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Provider Business Mailing Address
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Address Line | 10114 WINDALIER WAY
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City | ROSWELL
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State | GA
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Zip | 30076-1777
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Country | US
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Telephone |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH011476
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License Number State | GA
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