Provider Demographics
NPI:1467567974
Name:BUCH, ROBERT J (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:BUCH
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2864 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4227
Mailing Address - Country:US
Mailing Address - Phone:757-484-1780
Mailing Address - Fax:
Practice Address - Street 1:LANE & ASSOCIATES CORPORATE OFFICE
Practice Address - Street 2:19 EAST FRONT ST., BOX 2227
Practice Address - City:LILLINGTON,
Practice Address - State:NC
Practice Address - Zip Code:27546
Practice Address - Country:US
Practice Address - Phone:910-814-2944
Practice Address - Fax:910-893-8340
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA179666OtherANTHEM PROVIDER NUMBER
VA179666OtherANTHEM PROVIDER NUMBER