Provider Demographics
NPI:1154600013
Name:MARK J. BUCHWALDER D.D.S., L.L.C.
Entity type:Organization
Organization Name:MARK J. BUCHWALDER D.D.S., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUCHWALDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-479-6098
Mailing Address - Street 1:1237 N MONROE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-6609
Mailing Address - Country:US
Mailing Address - Phone:937-376-2441
Mailing Address - Fax:
Practice Address - Street 1:1237 N MONROE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-6609
Practice Address - Country:US
Practice Address - Phone:937-376-2441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH30018199261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental