Provider Demographics
NPI:1942404900
Name:BUCY, DONALD MARVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MARVIN
Last Name:BUCY
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 1:18151 NORMANDY TER SW
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3849
Mailing Address - Country:US
Mailing Address - Phone:120-624-3697
Mailing Address - Fax:
Practice Address - Street 1:18151 NORMANDY TER SW
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98166-3849
Practice Address - Country:US
Practice Address - Phone:120-624-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000033231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice