Provider Demographics
NPI:1124137823
Name:BUECKER & LONG PSC
Entity type:Organization
Organization Name:BUECKER & LONG PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BUECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-633-1915
Mailing Address - Street 1:1100 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:SHELLBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1462
Mailing Address - Country:US
Mailing Address - Phone:502-633-1915
Mailing Address - Fax:502-633-1098
Practice Address - Street 1:1100 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:SHELLBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1462
Practice Address - Country:US
Practice Address - Phone:502-633-1915
Practice Address - Fax:502-633-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty