MEDICARE: DR. MARK STEVEN BUEKER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5434	NC

General Provider Information

NPI Number	:	1245202886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK STEVEN BUEKER D.D.S.

Provider Business Mailing Address
First Line	:	116 COLINGTON LN
Second Line	:
City	:	KILL DEVIL HILLS
State	:	NC
Zip	:	27948-8057
Country	:	US
Telephone Number	:	252-441-4696
Fax Number	:	252-441-2233

Provider Business Practice Location Address
First Line	:	3118 N CROATAN HWY
Second Line	:	SUITE 102
City	:	KILL DEVIL HILLS
State	:	NC
Zip	:	27948-9254
Country	:	US
Telephone Number	:	252-441-5811
Fax Number	:	252-441-2233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/08/2007

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