Provider Demographics
NPI:1336639939
Name:BUCKEYE DENTISTRY LLC
Entity Type:Organization
Organization Name:BUCKEYE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-309-5560
Mailing Address - Street 1:134 BEEKIN DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1530
Mailing Address - Country:US
Mailing Address - Phone:614-309-5560
Mailing Address - Fax:
Practice Address - Street 1:7625 PEA RIDGE RD.
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133
Practice Address - Country:US
Practice Address - Phone:614-588-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023308261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental