Individual
CHARLES BUKOVAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
215 SOUTH STURGEON ST, MONTGOMERY CITY, MO 63361
(573) 564-3726
Mailing address
1687 DOVE RD, SORENTO, IL 62086-3254
(618) 604-2111
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2012029542
MO
Other
Enumeration date
12/05/2012
Last updated
12/05/2012
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