Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS 037976 | PA |
N | 1223E0200X | Endodontist | S7-70C | NV |
NPI | 1154525939 |
---|---|
Provider Name | Dr. Jared Thomas Buck |
First Address | Huntingdon Valley, PA 19006-2318 |
Second Address | Carson City, NV 89703-3874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 12/05/2010 |