Provider Demographics
NPI:1770157398
Name:BUCKEYE DENTAL, INC.
Entity type:Organization
Organization Name:BUCKEYE DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MATHENY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-366-3636
Mailing Address - Street 1:3220 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5102
Mailing Address - Country:US
Mailing Address - Phone:941-366-3636
Mailing Address - Fax:941-957-0624
Practice Address - Street 1:3220 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5102
Practice Address - Country:US
Practice Address - Phone:941-366-3636
Practice Address - Fax:941-957-0624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN24599OtherDENTAL LICENSE