Provider Demographics
NPI:1770760878
Name:BUCKINGHAM, STEPHEN KROST (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KROST
Last Name:BUCKINGHAM
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 1:2768 KINSAIL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2255
Mailing Address - Country:US
Mailing Address - Phone:850-766-4674
Mailing Address - Fax:
Practice Address - Street 1:2768 KINSAIL DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2255
Practice Address - Country:US
Practice Address - Phone:850-766-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL72121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry