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General NPI Number Information
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NPI Number | 1922576396
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Entity Type | Organization
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Legal Business Name | BRADLEY BUCHWALD DMD
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 6549 COIT RD STE 124
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City | FRISCO
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State | TX
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Zip | 75035
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Country | US
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Telephone | 972-377-5940
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Fax |
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Provider Business Mailing Address
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Address Line | 6549 COIT RD STE 124
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City | FRISCO
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State | TX
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Zip | 75035
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Country | US
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Telephone | 972-377-5940
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRADLEY JASON BUCHWALD
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Credential | DMD
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Telephone | 972-377-5940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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