MEDICARE: DR. STEPHEN KROST BUCKINGHAM 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
1	1223P0221X	Pediatric Dentistry	7212	FL

General Provider Information

NPI Number	:	1770760878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN KROST BUCKINGHAM DDS

Provider Business Mailing Address
First Line	:	2768 KINSAIL DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-2255
Country	:	US
Telephone Number	:	850-766-4674
Fax Number	:

Provider Business Practice Location Address
First Line	:	2768 KINSAIL DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-2255
Country	:	US
Telephone Number	:	850-766-4674
Fax Number	:

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

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/31/2008

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