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General NPI Number Information
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NPI Number | 1750482246
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Entity Type | Individual
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Provider Name | DR. MARK ROBINSON BUCKLEY
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 206 S MERIDIAN ST
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City | JASONVILLE
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State | IN
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Zip | 47438-1520
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Country | US
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Telephone | 812-665-2275
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Fax | 812-665-9374
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Provider Business Mailing Address
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Address Line | RR 2 BOX 189
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City | WORTHINGTON
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State | IN
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Zip | 47471-9759
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Country | US
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Telephone | 812-875-2505
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Fax | 812-665-9374
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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 | 12008304
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License Number State | IN
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