Provider Demographics
NPI:1093942187
Name:BUCHANAN, ALISSA MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:MARIE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:ALISSA
Other - Middle Name:MARIE
Other - Last Name:SIEJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:761 S MACARTHUR BLVD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4227
Mailing Address - Country:US
Mailing Address - Phone:972-393-9700
Mailing Address - Fax:
Practice Address - Street 1:761 S MACARTHUR BLVD
Practice Address - Street 2:SUITE 117
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4227
Practice Address - Country:US
Practice Address - Phone:972-393-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12893124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist