Provider Demographics
NPI:1073227385
Name:ERIC P BUCK DDS LEWIS CENTER LLC
Entity Type:Organization
Organization Name:ERIC P BUCK DDS LEWIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ACCOUNTS CORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STREETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-888-3692
Mailing Address - Street 1:9391 S. OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035
Mailing Address - Country:US
Mailing Address - Phone:614-888-3692
Mailing Address - Fax:614-436-7898
Practice Address - Street 1:9391 S. OLD STATE RD
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035
Practice Address - Country:US
Practice Address - Phone:614-888-3692
Practice Address - Fax:614-436-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty