Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 16121 | MD |
Y | 1223P0221X | Pediatric Dentist | DN014232 | GA |
NPI | 1073779211 |
---|---|
Provider Name | Dr. Eileen Buckle |
First Address | Marietta, GA 30066-3053 |
Second Address | Marietta, GA 30066-3053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2008 |
Last Update Date | 03/05/2016 |