Provider Demographics
NPI:1710196902
Name:DR. SUSAN BUCKLAND DDS
Entity Type:Organization
Organization Name:DR. SUSAN BUCKLAND DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUCKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-295-9700
Mailing Address - Street 1:3 REGIONAL CIRCLE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-0003
Mailing Address - Country:US
Mailing Address - Phone:910-295-9700
Mailing Address - Fax:910-295-7075
Practice Address - Street 1:3 REGIONAL CIR.
Practice Address - Street 2:SUITE A
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-0003
Practice Address - Country:US
Practice Address - Phone:910-295-9700
Practice Address - Fax:910-295-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC67551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7990066Medicaid