Provider Demographics
NPI:1528290889
Name:BUCK'S TREASURE PLLC
Entity type:Organization
Organization Name:BUCK'S TREASURE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:CHRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-465-3001
Mailing Address - Street 1:P.O. BOX 748
Mailing Address - Street 2:9500 RED ARROW HWY
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106
Mailing Address - Country:US
Mailing Address - Phone:269-465-3001
Mailing Address - Fax:269-465-3001
Practice Address - Street 1:9500 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106
Practice Address - Country:US
Practice Address - Phone:269-465-3001
Practice Address - Fax:269-465-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty