Provider Demographics
NPI:1497729404
Name:BUCKMASTER, DENNIS DEWITT (MS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:DEWITT
Last Name:BUCKMASTER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 NW MEANDER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-1014
Mailing Address - Country:US
Mailing Address - Phone:541-265-2858
Mailing Address - Fax:
Practice Address - Street 1:4909 S COAST HWY
Practice Address - Street 2:
Practice Address - City:SOUTH BEACH
Practice Address - State:OR
Practice Address - Zip Code:97366-9648
Practice Address - Country:US
Practice Address - Phone:541-574-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR50976101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health