Provider Demographics
NPI:1578603049
Name:BUCAJ, ALFONS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALFONS
Middle Name:
Last Name:BUCAJ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 37TH ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6591
Mailing Address - Country:US
Mailing Address - Phone:772-567-9550
Mailing Address - Fax:772-567-9517
Practice Address - Street 1:1880 37TH ST
Practice Address - Street 2:SUITE #3
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6591
Practice Address - Country:US
Practice Address - Phone:772-567-9550
Practice Address - Fax:772-567-9517
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice