Provider Demographics
NPI:1780606897
Name:BUFANO & BUFANO DDS PA
Entity type:Organization
Organization Name:BUFANO & BUFANO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-781-2234
Mailing Address - Street 1:3386 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7233
Mailing Address - Country:US
Mailing Address - Phone:919-781-2234
Mailing Address - Fax:919-781-1642
Practice Address - Street 1:3386 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7233
Practice Address - Country:US
Practice Address - Phone:919-781-2234
Practice Address - Fax:919-781-1642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890314CMedicaid