Provider Demographics
NPI:1780256321
Name:BUCKLEY, KATHARINA CLARE (DMD)
Entity type:Individual
Prefix:
First Name:KATHARINA
Middle Name:CLARE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 LINCOLN STREET 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-4079
Mailing Address - Fax:
Practice Address - Street 1:CMR 411
Practice Address - Street 2:
Practice Address - City:APO/AE
Practice Address - State:GERMANY
Practice Address - Zip Code:09112
Practice Address - Country:DE
Practice Address - Phone:314-590-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN25837OtherDENTAL LICENSE