Provider Demographics
NPI:1922576396
Name:BRADLEY BUCHWALD DMD
Entity Type:Organization
Organization Name:BRADLEY BUCHWALD DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:BUCHWALD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-377-5940
Mailing Address - Street 1:6549 COIT RD
Mailing Address - Street 2:STE 124
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:972-377-5940
Mailing Address - Fax:
Practice Address - Street 1:6549 COIT RD
Practice Address - Street 2:STE 124
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:972-377-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1639426521OtherNPPES