Provider Demographics
NPI:1891993135
Name:BUCK, DENNIS MILTON (MS)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MILTON
Last Name:BUCK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 CROSSLANES ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1814
Mailing Address - Country:US
Mailing Address - Phone:989-773-1643
Mailing Address - Fax:
Practice Address - Street 1:907 CROSSLANES ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1814
Practice Address - Country:US
Practice Address - Phone:989-773-1643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003974103TB0200X
MI68010168131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical