MEDICARE: DR. JOSEPH RICHARD BUKOWSKI 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	122300000X	Dentist	DS020505L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982748455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH RICHARD BUKOWSKI DDS

Provider Business Mailing Address
First Line	:	PO BOX 369
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16512-0369
Country	:	US
Telephone Number	:	814-454-4530
Fax Number	:	814-456-2375

Provider Business Practice Location Address
First Line	:	312 CHESTNUT ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16507-1222
Country	:	US
Telephone Number	:	814-454-4530
Fax Number	:	814-456-2375

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

Provider Enumeration Date	:	02/17/2007
Last Update Date	:	09/06/2008

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