Provider Demographics
NPI:1124694252
Name:BUCKNER, ANDREW STEPHEN
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEPHEN
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 N AMES AVE APT E
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-4859
Mailing Address - Country:US
Mailing Address - Phone:417-214-5848
Mailing Address - Fax:
Practice Address - Street 1:1508 NE 96TH ST STE A
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1396
Practice Address - Country:US
Practice Address - Phone:816-415-5808
Practice Address - Fax:816-415-8083
Is Sole Proprietor?:No
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021019497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist