Provider Demographics
NPI:1598465403
Name:DELTON FAMILY DENTAL
Entity Type:Organization
Organization Name:DELTON FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUEKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-623-4059
Mailing Address - Street 1:10123 S M 43 HWY
Mailing Address - Street 2:
Mailing Address - City:DELTON
Mailing Address - State:MI
Mailing Address - Zip Code:49046-8808
Mailing Address - Country:US
Mailing Address - Phone:269-623-4059
Mailing Address - Fax:269-623-4072
Practice Address - Street 1:10123 S M 43 HWY
Practice Address - Street 2:
Practice Address - City:DELTON
Practice Address - State:MI
Practice Address - Zip Code:49046-8808
Practice Address - Country:US
Practice Address - Phone:269-623-4059
Practice Address - Fax:269-623-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental