Individual
TENNISHA BUCKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
401 S GLOSTER ST, TUPELO, MS 38801-5540
(662) 269-4027
Mailing address
118A WOODSTONE PL, CLINTON, MS 39056-4936
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3870-16
MS
Other
Enumeration date
06/13/2016
Last updated
06/13/2016
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