Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5270 | NC |
NPI | 1013185065 |
---|---|
Provider Name | James Buckthal |
First Address | Raleigh, NC 27608-1020 |
Second Address | Raleigh, NC 27608-1020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 12/02/2008 |