Provider Demographics
NPI:1558546390
Name:BUKSA, EUGENE J (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:J
Last Name:BUKSA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 W 55TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3566
Mailing Address - Country:US
Mailing Address - Phone:708-354-4545
Mailing Address - Fax:708-354-0336
Practice Address - Street 1:475 W 55TH ST STE 201
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3566
Practice Address - Country:US
Practice Address - Phone:708-354-4545
Practice Address - Fax:708-354-0336
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics