Provider Demographics
NPI:1891145546
Name:BUCKMAN, MARY VIRGINIA MAYO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY VIRGINIA
Middle Name:MAYO
Last Name:BUCKMAN
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 1:2500 VILLAGE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3748
Mailing Address - Country:US
Mailing Address - Phone:910-487-0807
Mailing Address - Fax:910-487-0389
Practice Address - Street 1:2500 VILLAGE DR
Practice Address - Street 2:STE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3748
Practice Address - Country:US
Practice Address - Phone:910-487-0807
Practice Address - Fax:910-487-0389
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist