Provider Demographics
NPI:1649252891
Name:BUKSAR, DAVID MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:BUKSAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 E MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1743
Mailing Address - Country:US
Mailing Address - Phone:765-352-0250
Mailing Address - Fax:765-352-0254
Practice Address - Street 1:3745 SOUTH MADISON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302
Practice Address - Country:US
Practice Address - Phone:765-896-9857
Practice Address - Fax:765-352-0254
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009906A1223G0001X
IN120099061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200233800Medicaid