Provider Demographics
NPI:1023175643
Name:BUCHWALD, MAXEY STANTON (DDS)
Entity type:Individual
Prefix:DR
First Name:MAXEY
Middle Name:STANTON
Last Name:BUCHWALD
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 1:1701 OLD COURSE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4933
Mailing Address - Country:US
Mailing Address - Phone:972-407-5838
Mailing Address - Fax:
Practice Address - Street 1:300 N. COIT RD.
Practice Address - Street 2:SUITE 245
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-644-3280
Practice Address - Fax:972-671-7925
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice