Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN006943 | GA |
NPI | 1063697217 |
---|---|
Provider Name | Dr. Richard Fuller Buhl |
First Address | Jasper, GA 30143-1600 |
Second Address | Jasper, GA 30143-1600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2008 |
Last Update Date | 07/01/2008 |