Provider Demographics
NPI:1508876954
Name:BUCKLEY, MARGARET MARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:MARY
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:MARGARET
Other - Middle Name:MARY
Other - Last Name:BUCKLEY-KUC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:205 WESTERN AV
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904
Mailing Address - Country:US
Mailing Address - Phone:781-598-1101
Mailing Address - Fax:781-598-1101
Practice Address - Street 1:205 WESTERN AV
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904
Practice Address - Country:US
Practice Address - Phone:781-598-1101
Practice Address - Fax:781-598-1101
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0298832Medicaid
MAX05642OtherBLUE CROSS BLUE SHIELD