Provider Demographics
NPI:1750640983
Name:ROBERT L. BUCKLES, DMD, INC.
Entity Type:Organization
Organization Name:ROBERT L. BUCKLES, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:BUCKLES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-596-0312
Mailing Address - Street 1:4100 W 15TH ST
Mailing Address - Street 2:SUITE104
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5803
Mailing Address - Country:US
Mailing Address - Phone:972-596-0312
Mailing Address - Fax:972-867-7041
Practice Address - Street 1:4100 W 15TH ST
Practice Address - Street 2:SUITE104
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5803
Practice Address - Country:US
Practice Address - Phone:972-596-0312
Practice Address - Fax:972-867-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11254261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery