Provider Demographics
NPI:1376761130
Name:W. CHARLES BUCHSIEB II, DDS, INC.
Entity Type:Organization
Organization Name:W. CHARLES BUCHSIEB II, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTISTS
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BUCHSIEB II
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-747-3600
Mailing Address - Street 1:2184 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1203
Mailing Address - Country:US
Mailing Address - Phone:419-747-3600
Mailing Address - Fax:419-747-3605
Practice Address - Street 1:2184 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1203
Practice Address - Country:US
Practice Address - Phone:419-747-3600
Practice Address - Fax:419-747-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH177091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty