Provider Demographics
NPI:1558033050
Name:THE BUCKLEY DENTAL CENTER PC
Entity Type:Organization
Organization Name:THE BUCKLEY DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:ELISHA
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-524-7364
Mailing Address - Street 1:4807 WIGLEY RD NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-1503
Mailing Address - Country:US
Mailing Address - Phone:678-524-7364
Mailing Address - Fax:
Practice Address - Street 1:2325 GLENWOOD AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2362
Practice Address - Country:US
Practice Address - Phone:678-800-8316
Practice Address - Fax:678-800-8317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental