Provider Demographics
NPI:1215222096
Name:BUCKLAN, RONNI SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONNI
Middle Name:SUE
Last Name:BUCKLAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WEST END AVENUE
Mailing Address - Street 2:16AB
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-721-8447
Mailing Address - Fax:718-398-2792
Practice Address - Street 1:367 WEST 49 STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-367-7120
Practice Address - Fax:718-398-2792
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0425881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics