Provider Demographics
NPI:1043339633
Name:BUCKLES, ROBERT LAWSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWSON
Last Name:BUCKLES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W 15TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5803
Mailing Address - Country:US
Mailing Address - Phone:972-596-0312
Mailing Address - Fax:972-867-7041
Practice Address - Street 1:4100 W 15TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5803
Practice Address - Country:US
Practice Address - Phone:972-596-0312
Practice Address - Fax:972-867-7041
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8112445OtherBLUE LINK
TX0034116OtherHARRIS METHODIST
TX4549321004OtherCIGNA
TXTX1392OtherAETNA DMO
TX4248067OtherAETNA PPO
TXFB73OtherBLUE CROSS BLUE SHIELD
TX188533OtherUNITED CONCORDIA
TX0735300OtherAETNA HMO
TX8112445OtherBLUE LINK
TX00FB73Medicare ID - Type Unspecified