Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 20326 | CA |
NPI | 1003252081 |
---|---|
Provider Name | Dr. Bert C. Buffington |
First Address | San Diego, CA 92126-4560 |
Second Address | San Diego, CA 92126-4560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2013 |
Last Update Date | 16/05/2013 |