Provider Demographics
NPI:1447415849
Name:BUXTON, KENDELL THERON (DDS)
Entity type:Individual
Prefix:DR
First Name:KENDELL
Middle Name:THERON
Last Name:BUXTON
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 1:106 UNDERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4290
Mailing Address - Country:US
Mailing Address - Phone:505-609-9544
Mailing Address - Fax:
Practice Address - Street 1:1331 E PROSPECT RD UNIT B2
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1367
Practice Address - Country:US
Practice Address - Phone:970-482-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNMDD3013122300000X
OH30-023673122300000X
CO00202193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist