Provider Demographics
NPI:1679782585
Name:J. STEPHEN BUCKLER, DMD, PC
Entity type:Organization
Organization Name:J. STEPHEN BUCKLER, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BUCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-491-0960
Mailing Address - Street 1:3632 CHAMBLEE TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4418
Mailing Address - Country:US
Mailing Address - Phone:770-491-0960
Mailing Address - Fax:
Practice Address - Street 1:3632 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4418
Practice Address - Country:US
Practice Address - Phone:770-491-0960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8406261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental