Provider Demographics
NPI:1619398856
Name:BUXTON DENTAL PC
Entity Type:Organization
Organization Name:BUXTON DENTAL PC
Other - Org Name:MAINE FAMILY DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-947-1166
Mailing Address - Street 1:792 STILLWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3617
Mailing Address - Country:US
Mailing Address - Phone:207-947-1166
Mailing Address - Fax:207-947-6123
Practice Address - Street 1:792 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-947-1166
Practice Address - Fax:207-947-6123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN41461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty