Provider Demographics
NPI:1669528394
Name:BUCKSTEIN, JAN BARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:BARRY
Last Name:BUCKSTEIN
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 1:1660 S ALBION ST
Mailing Address - Street 2:SUITE 718
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4008
Mailing Address - Country:US
Mailing Address - Phone:303-757-7759
Mailing Address - Fax:303-757-1501
Practice Address - Street 1:1660 S ALBION ST
Practice Address - Street 2:SUITE 718
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4008
Practice Address - Country:US
Practice Address - Phone:303-757-7759
Practice Address - Fax:303-757-1501
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics