Provider Demographics
NPI:1669043022
Name:BUKATA, CHRISTINA NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:BUKATA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 NW 40TH TER STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8148
Mailing Address - Country:US
Mailing Address - Phone:754-242-4111
Mailing Address - Fax:
Practice Address - Street 1:3731 NW 40TH TER STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8148
Practice Address - Country:US
Practice Address - Phone:352-562-0863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261951223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty