Provider Demographics
NPI:1770606428
Name:BUZBEE, ROGER D (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:BUZBEE
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 1:2104 W CHESTERFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8650
Mailing Address - Country:US
Mailing Address - Phone:417-888-0771
Mailing Address - Fax:417-888-0784
Practice Address - Street 1:2104 W CHESTERFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-8650
Practice Address - Country:US
Practice Address - Phone:417-888-0771
Practice Address - Fax:417-888-0784
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0148841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO402530232Medicaid