MEDICARE: BUCKENHEIMER & BULNES, D.M.D.'S P.A.

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	15541	FL

General Provider Information

NPI Number	:	1346728425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKENHEIMER & BULNES, D.M.D.'S P.A.

Provider Business Mailing Address
First Line	:	3906 W. NEPTUNE ST.
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5829
Country	:	US
Telephone Number	:	813-259-9000
Fax Number	:	813-259-9923

Provider Business Practice Location Address
First Line	:	3906 W. NEPTUNE ST.
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5829
Country	:	US
Telephone Number	:	813-259-9000
Fax Number	:	813-259-9923

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHRISTOPHER MICHAEL BULNES
Credential	:	D.M.D.
Telephone Number	:	813-259-9000

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	08/01/2018

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