Provider Demographics
NPI:1639211345
Name:COZART, BUCKLEY WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BUCKLEY
Middle Name:WAYNE
Last Name:COZART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 HILLANDALE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3032
Mailing Address - Country:US
Mailing Address - Phone:919-286-4481
Mailing Address - Fax:
Practice Address - Street 1:1106 HILLANDALE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3032
Practice Address - Country:US
Practice Address - Phone:919-286-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice