Provider Demographics
NPI:1629469655
Name:MICHAEL D BUCK DDS, PC
Entity Type:Organization
Organization Name:MICHAEL D BUCK DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-782-4747
Mailing Address - Street 1:803 N SUMNER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1350
Mailing Address - Country:US
Mailing Address - Phone:641-782-4747
Mailing Address - Fax:641-782-8004
Practice Address - Street 1:803 N SUMNER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1350
Practice Address - Country:US
Practice Address - Phone:641-782-4747
Practice Address - Fax:641-782-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty