MEDICARE: BUCKLIN FAMILY DENTISTRY

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	2901019767	MI

General Provider Information

NPI Number	:	1982041901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKLIN FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	32 DIVISION ST
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-1966
Country	:	US
Telephone Number	:	517-278-7436
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 DIVISION ST
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-1966
Country	:	US
Telephone Number	:	517-278-7436
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. AMANDA MARIE BUCKLIN
Credential	:	DDS
Telephone Number	:	517-745-8222

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	05/30/2013

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Directions to “BUCKLIN FAMILY DENTISTRY ” Practice Location

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