Provider Demographics
NPI:1932430451
Name:BUCK, JOHN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:BUCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 N FRESNO STREET
Mailing Address - Street 2:104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-431-9104
Mailing Address - Fax:559-431-8166
Practice Address - Street 1:7730 N FRESNO ST
Practice Address - Street 2:104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2408
Practice Address - Country:US
Practice Address - Phone:559-431-9104
Practice Address - Fax:559-431-8166
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist