Provider Demographics
NPI:1356774756
Name:BUCKLEY, KATHRYN (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 SAND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2434
Mailing Address - Country:US
Mailing Address - Phone:443-852-3176
Mailing Address - Fax:
Practice Address - Street 1:576 SAND CREEK RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2434
Practice Address - Country:US
Practice Address - Phone:518-869-5348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist