Bucca Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D11889 Issued in MN

Legal business name

BUCCA DENTAL LLC

Practice address

1508 E Lake St
Minneapolis, MN 55407-1720

Phone

(612) 724-1717

Fax

(612) 724-3114

NPI assigned

Mar 5, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Edgar Fernando Mantilla, DDS

Title

Ceo

Phone

(612) 724-1717

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425513600000",
    "number": "1750774428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 E LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071720",
            "telephone_number": "612-724-1717",
            "fax_number": "612-724-3114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 E LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071720",
            "telephone_number": "612-724-1717",
            "fax_number": "612-724-3114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCCA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-05",
        "last_updated": "2015-03-05",
        "status": "A",
        "authorized_official_last_name": "MANTILLA",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_middle_name": "FERNANDO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-724-1717",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "D11889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Fang Bu, M.D.
• Kathleen Hatke Bubolz, MA, CCC-SLP
• Florian Bubser
• Lisa Luann Buchal, MSW, LICSW
• Adam Buchalski
• Anne Eileen Buchanan, M.S, L.P.
• Gretchen Buchanan, MA, LMFT, LADC
• Nicole Marie Buchanan

• Dental Clinic/Center in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.