Provider Demographics
NPI:1215592993
Name:BUCKLEY DENTAL LOFT
Entity Type:Organization
Organization Name:BUCKLEY DENTAL LOFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:036-963-6763
Mailing Address - Street 1:1710 S BUCKLEY RD UNIT 8A
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5639
Mailing Address - Country:US
Mailing Address - Phone:303-696-6763
Mailing Address - Fax:
Practice Address - Street 1:1710 S BUCKLEY RD UNIT 8A
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-5639
Practice Address - Country:US
Practice Address - Phone:303-696-6763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty