Provider Demographics
NPI:1003819756
Name:BUXTON, JUDY LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:LYNN
Last Name:BUXTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 CLAIREMONT RD
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1706
Mailing Address - Country:US
Mailing Address - Phone:610-525-6060
Mailing Address - Fax:610-525-3302
Practice Address - Street 1:234 S BRYN MAWR AVE
Practice Address - Street 2:STE 203
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2133
Practice Address - Country:US
Practice Address - Phone:610-525-6060
Practice Address - Fax:610-525-3302
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022498-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice