Provider Demographics
NPI:1508988635
Name:VANBUSKIRK, CAROLYN (DDS)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 22ND DRIVE
Mailing Address - Street 2:APT#2 A
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105
Mailing Address - Country:US
Mailing Address - Phone:212-688-0824
Mailing Address - Fax:212-826-5089
Practice Address - Street 1:30 CENTRAL PARK S
Practice Address - Street 2:SUITE #12 A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1628
Practice Address - Country:US
Practice Address - Phone:212-688-0824
Practice Address - Fax:212-826-5089
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0461271223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health