Provider Demographics
NPI:1891224861
Name:BUCKNER, JOSHUA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 EMERY HWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3666
Mailing Address - Country:US
Mailing Address - Phone:770-359-8979
Mailing Address - Fax:
Practice Address - Street 1:4562 FORSYTH RD # 1
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-0510
Practice Address - Country:US
Practice Address - Phone:478-477-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0153901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice