Provider Demographics
NPI:1700153483
Name:MICHAEL BUFO DMD LLC
Entity Type:Organization
Organization Name:MICHAEL BUFO DMD LLC
Other - Org Name:WINDHAM DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-893-2001
Mailing Address - Street 1:4 COMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5554
Mailing Address - Country:US
Mailing Address - Phone:207-893-2001
Mailing Address - Fax:207-893-2006
Practice Address - Street 1:4 COMMONS AVE
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5554
Practice Address - Country:US
Practice Address - Phone:207-893-2001
Practice Address - Fax:207-893-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty