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NPI Code Detail

MEDICARE: DR. PAULA ELAINE VANBUSKIRK DDS

MEDICARE: DR. PAULA ELAINE VANBUSKIRK DDS
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
11223P0221XPediatric Dentistry5245OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
220-0692426OTHEROKFED TAX ID

General Provider Information

NPI Number : 1689701518
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAULA ELAINE VANBUSKIRK DDS
Provider Business Mailing Address
First Line : 1212 ARLINGTON ST
Second Line :
City : ADA
State : OK
Zip : 74820-4045
Country : US
Telephone Number : 580-332-6767
Fax Number : 580-421-9739
Provider Business Practice Location Address
First Line : 1212 ARLINGTON ST
Second Line :
City : ADA
State : OK
Zip : 74820-4045
Country : US
Telephone Number : 580-332-6767
Fax Number : 580-421-9739
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2007
Last Update Date : 05/18/2015

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