Provider Demographics
NPI:1194347161
Name:BUCKLER, ADAM HARRISON (DDS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:HARRISON
Last Name:BUCKLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1216
Mailing Address - Country:US
Mailing Address - Phone:740-935-4702
Mailing Address - Fax:
Practice Address - Street 1:64 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2420
Practice Address - Country:US
Practice Address - Phone:740-775-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0261031223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice