Provider Demographics
NPI:1457609356
Name:BUFFINGTON DENTAL
Entity Type:Organization
Organization Name:BUFFINGTON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-892-4296
Mailing Address - Street 1:PO BOX 1120
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-1120
Mailing Address - Country:US
Mailing Address - Phone:406-892-4296
Mailing Address - Fax:
Practice Address - Street 1:604 1ST AVE W
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-3620
Practice Address - Country:US
Practice Address - Phone:406-892-4296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1346404688OtherGENERAL PRACTICE DENTISTRY