Provider Demographics
NPI:1639324122
Name:BUCK, RICHARD ERVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ERVIN
Last Name:BUCK
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 1:556 W BEDFORD EULESS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3924
Mailing Address - Country:US
Mailing Address - Phone:817-268-2111
Mailing Address - Fax:817-280-9643
Practice Address - Street 1:556 W BEDFORD EULESS RD
Practice Address - Street 2:SUITE A
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3924
Practice Address - Country:US
Practice Address - Phone:817-268-2111
Practice Address - Fax:817-280-9643
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice