Provider Demographics
NPI:1720476229
Name:BRANDY R. BUCKNER, DDS, PC
Entity Type:Organization
Organization Name:BRANDY R. BUCKNER, DDS, PC
Other - Org Name:KINDRED OAKS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-452-6458
Mailing Address - Street 1:1170 US HWY 1
Mailing Address - Street 2:SUITE100/110
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596
Mailing Address - Country:US
Mailing Address - Phone:919-452-6458
Mailing Address - Fax:
Practice Address - Street 1:1170 US 1 HWY
Practice Address - Street 2:STE 110
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-9020
Practice Address - Country:US
Practice Address - Phone:919-452-6458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty