# SOUTHWAY FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902154248
- **Authorized official:** DR. DAVID M BUKSAR DDS (OWNER)
- **Authorized official phone:** (765) 896-9857

## Contact information

- **Practice address:** 3745 S MADISON ST, MUNCIE, IN 47302-5756
- **Practice address phone:** (765) 896-9857
- **Practice address fax:** (765) 896-9937
- **Mailing address:** 3745 S. MADISON ST, MUNCIE, IN 47302-5756
- **Mailing address phone:** (765) 896-9857

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009906A | IN | Yes |

## Other

- **Enumeration date:** 08/16/2012
- **Last updated:** 08/16/2012