Basic Information
| Provider Information | |||||||||
| NPI: | 1497729404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCKMASTER | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | DEWITT | ||||||||
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| Credential: | M.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 NW MEANDER AVE | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973651014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412652858 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4909 S COAST HWY | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEACH | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973669648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415745960 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 50976 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.