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General NPI Number Information
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NPI Number | 1982041901
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Entity Type | Organization
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Legal Business Name | BUCKLIN FAMILY DENTISTRY
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 32 DIVISION ST
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City | COLDWATER
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State | MI
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Zip | 49036-1966
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Country | US
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Telephone | 517-278-7436
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Fax |
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Provider Business Mailing Address
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Address Line | 32 DIVISION ST
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City | COLDWATER
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State | MI
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Zip | 49036-1966
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Country | US
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Telephone | 517-278-7436
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. AMANDA MARIE BUCKLIN
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Credential | DDS
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Telephone | 517-745-8222
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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 | 2901019767
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License Number State | MI
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