Provider Demographics
NPI:1952386609
Name:BUXBAUM, ROBERT MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:BUXBAUM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ANDOVER ROAD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821
Mailing Address - Country:US
Mailing Address - Phone:978-392-9095
Mailing Address - Fax:978-392-9912
Practice Address - Street 1:2 ANDOVER ROAD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821
Practice Address - Country:US
Practice Address - Phone:978-663-8600
Practice Address - Fax:978-663-2880
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15125122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA015125OtherTUFTS
MA40331OtherHARVARD
MA40331OtherHARVARD
MAX04640Medicare ID - Type Unspecified