Provider Demographics
NPI:1700183746
Name:BUCHMAN, MARK EDWARD
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:BUCHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 W ROBINHOOD DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5513
Mailing Address - Country:US
Mailing Address - Phone:209-473-7336
Mailing Address - Fax:209-473-8377
Practice Address - Street 1:1372 W ROBINHOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5513
Practice Address - Country:US
Practice Address - Phone:209-473-7336
Practice Address - Fax:209-473-8377
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics