Provider Demographics
NPI:1427104470
Name:BUCK, DAVE L (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVE
Middle Name:L
Last Name:BUCK
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 1:803 N SUMNER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1350
Mailing Address - Country:US
Mailing Address - Phone:641-782-2817
Mailing Address - Fax:641-782-8004
Practice Address - Street 1:803 N SUMNER AVE STE A
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1350
Practice Address - Country:US
Practice Address - Phone:641-782-2817
Practice Address - Fax:641-782-8004
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1427104470Medicaid