Provider Demographics
NPI:1689701518
Name:VANBUSKIRK, PAULA ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ELAINE
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4045
Mailing Address - Country:US
Mailing Address - Phone:580-332-6767
Mailing Address - Fax:580-421-9739
Practice Address - Street 1:1212 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4045
Practice Address - Country:US
Practice Address - Phone:580-332-6767
Practice Address - Fax:580-421-9739
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200020250AMedicaid
OK20-0692426OtherFED TAX ID