Provider Demographics
NPI:1023415205
Name:BUCK LINTHICUM D.D.S., P.A.
Entity type:Organization
Organization Name:BUCK LINTHICUM D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:WAYLAND
Authorized Official - Middle Name:H
Authorized Official - Last Name:LINTHICUM
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:336-854-2990
Mailing Address - Street 1:604 DOLLEY MADISON RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4206
Mailing Address - Country:US
Mailing Address - Phone:336-854-2990
Mailing Address - Fax:336-856-0776
Practice Address - Street 1:604 DOLLEY MADISON RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4206
Practice Address - Country:US
Practice Address - Phone:336-854-2990
Practice Address - Fax:336-856-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty