Provider Demographics
NPI:1447683842
Name:BUCKLEY, ROBERT P (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:BUCKLEY
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 1:255 PATROON CREEK BLVD
Mailing Address - Street 2:APT 3452
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-5016
Mailing Address - Country:US
Mailing Address - Phone:518-312-9425
Mailing Address - Fax:
Practice Address - Street 1:1 EASTVIEW RD
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-2402
Practice Address - Country:US
Practice Address - Phone:518-674-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057357-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist