Provider Demographics
NPI:1053457622
Name:BUFORD DENTISTRY
Entity Type:Organization
Organization Name:BUFORD DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-945-7186
Mailing Address - Street 1:1879 BUFORD HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3628
Mailing Address - Country:US
Mailing Address - Phone:770-945-7186
Mailing Address - Fax:770-945-1155
Practice Address - Street 1:1879 BUFORD HWY STE 5
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3628
Practice Address - Country:US
Practice Address - Phone:770-945-7186
Practice Address - Fax:770-945-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty