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General NPI Number Information
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NPI Number | 1891080917
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Entity Type | Individual
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Provider Name | MICHAEL DAVID BUCK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 803 N SUMNER AVE SUITE A
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City | CRESTON
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State | IA
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Zip | 50801-1350
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Country | US
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Telephone | 641-782-4747
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Fax | 641-782-8004
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Provider Business Mailing Address
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Address Line | 803 N SUMNER AVE SUITE A
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City | CRESTON
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State | IA
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Zip | 50801-1350
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Country | US
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Telephone | 641-782-4747
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Fax | 641-782-8004
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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 | 6747-15
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 08863
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License Number State | IA
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