Provider Demographics
NPI:1013329879
Name:BUCKLEY, KELSEY ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:ELIZABETH
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 S 40TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5259
Mailing Address - Country:US
Mailing Address - Phone:402-488-0959
Mailing Address - Fax:402-488-2169
Practice Address - Street 1:1919 S 40TH ST STE 103
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5259
Practice Address - Country:US
Practice Address - Phone:402-488-0959
Practice Address - Fax:402-488-2169
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist