Provider Demographics
NPI:1891080917
Name:BUCK, MICHAEL DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
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 1:803 N SUMNER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1350
Mailing Address - Country:US
Mailing Address - Phone:641-782-4747
Mailing Address - Fax:641-782-8004
Practice Address - Street 1:803 N SUMNER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1350
Practice Address - Country:US
Practice Address - Phone:641-782-4747
Practice Address - Fax:641-782-8004
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6747-151223G0001X
IA088631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice