Provider Demographics
NPI:1548665532
Name:BUCKENHEIMER, TERRY LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:BUCKENHEIMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 W NEPTUNE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5829
Mailing Address - Country:US
Mailing Address - Phone:813-857-3989
Mailing Address - Fax:813-259-9923
Practice Address - Street 1:3906 W NEPTUNE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5829
Practice Address - Country:US
Practice Address - Phone:813-857-3989
Practice Address - Fax:813-259-9923
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist