Basic Information
Provider Information
NPI: 1871895219
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUCKLER
FirstName: PHILIP
MiddleName: T
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5005 N PIEDRAS
Address2:  
City: EL PASO
State: TX
PostalCode: 799205001
CountryCode: US
TelephoneNumber: 9157423570
FaxNumber:  
Practice Location
Address1: 5005 N PIEDRAS
Address2: USA DENTAL ACTIVITY
City: EL PASO
State: TX
PostalCode: 799205001
CountryCode: US
TelephoneNumber: 9157423570
FaxNumber: 5804424002
Other Information
ProviderEnumerationDate: 11/17/2010
LastUpdateDate: 01/22/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X28627TXY Dental ProvidersDentist 

No ID Information.


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