Provider Demographics
NPI:1639155278
Name:BUXTON, CHARLES MARK (DMD, MS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MARK
Last Name:BUXTON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 NE ELAM YOUNG PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6422
Mailing Address - Country:US
Mailing Address - Phone:503-924-2248
Mailing Address - Fax:503-924-2241
Practice Address - Street 1:5625 NE ELAM YOUNG PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6422
Practice Address - Country:US
Practice Address - Phone:503-924-2248
Practice Address - Fax:503-924-2241
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD79701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics