Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 51000028 | OH |
NPI | 1164702775 |
---|---|
Provider Name | Mary Kathryn Buckler |
First Address | Cincinnati, OH 45229-3014 |
Second Address | Cincinnati, OH 45229-3014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2011 |
Last Update Date | 26/08/2011 |