Provider Demographics
NPI:1376553412
Name:BUHLER JR, JOHN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:BUHLER JR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 D EAST STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-6963
Mailing Address - Country:US
Mailing Address - Phone:260-423-2340
Mailing Address - Fax:260-422-5342
Practice Address - Street 1:4606 D EAST STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-6963
Practice Address - Country:US
Practice Address - Phone:260-423-2340
Practice Address - Fax:260-422-5342
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1266891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200029030Medicaid
INT69231Medicare UPIN
IN059750Medicare PIN
IN256430CMedicare PIN