Provider Demographics
NPI:1356475750
Name:BUFFETT, CONSTANCE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:A
Last Name:BUFFETT
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 1:601 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2947
Mailing Address - Country:US
Mailing Address - Phone:215-855-9068
Mailing Address - Fax:215-855-2854
Practice Address - Street 1:601 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2947
Practice Address - Country:US
Practice Address - Phone:215-855-9068
Practice Address - Fax:215-855-2854
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024614-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice