Provider Demographics
NPI:1558677724
Name:BUCKLEY, PAOLA ANDREA (DMD, DSC,)
Entity type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:ANDREA
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:DMD, DSC,
Other - Prefix:DR
Other - First Name:PAOLA
Other - Middle Name:ANDREA
Other - Last Name:HURTADO-BUCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 LEIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1719
Mailing Address - Country:US
Mailing Address - Phone:781-974-9308
Mailing Address - Fax:
Practice Address - Street 1:9 LEIGHTON ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1719
Practice Address - Country:US
Practice Address - Phone:781-974-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18570141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty