Provider Demographics
NPI:1114270766
Name:BUCKINGHAM FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:BUCKINGHAM FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CARY
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-983-2826
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:DILLWYN
Mailing Address - State:VA
Mailing Address - Zip Code:23936-0069
Mailing Address - Country:US
Mailing Address - Phone:434-983-2826
Mailing Address - Fax:434-983-2714
Practice Address - Street 1:15911 N JAMES MADISON HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:DILLWYN
Practice Address - State:VA
Practice Address - Zip Code:23936-3342
Practice Address - Country:US
Practice Address - Phone:434-983-2826
Practice Address - Fax:434-983-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010035811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty