Provider Demographics
NPI:1982885638
Name:BUCKLEY, ELIZABETH CORINNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CORINNE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CORINNE
Other - Last Name:WELFARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:359 FRONT ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017
Mailing Address - Country:US
Mailing Address - Phone:440-234-2813
Mailing Address - Fax:440-234-7820
Practice Address - Street 1:359 FRONT ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017
Practice Address - Country:US
Practice Address - Phone:440-234-2813
Practice Address - Fax:440-234-7820
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300226121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice