Provider Demographics
NPI:1407371628
Name:ERIC P BUCK DDS INC
Entity Type:Organization
Organization Name:ERIC P BUCK DDS INC
Other - Org Name:DISTINCTIVE SMILES OF DUBLIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-792-1800
Mailing Address - Street 1:5142 BLAZER PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1339
Mailing Address - Country:US
Mailing Address - Phone:614-792-1800
Mailing Address - Fax:614-792-2687
Practice Address - Street 1:5142 BLAZER PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1339
Practice Address - Country:US
Practice Address - Phone:614-792-1800
Practice Address - Fax:614-792-2687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIC P BUCK DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021908261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental