Provider Demographics
NPI:1356469282
Name:BUCHANAN, JOHN WHITTAKER (DMD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WHITTAKER
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 PARK ST
Mailing Address - Street 2:STE 100
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101
Mailing Address - Country:US
Mailing Address - Phone:270-781-3133
Mailing Address - Fax:270-846-0193
Practice Address - Street 1:546 PARK ST
Practice Address - Street 2:STE 100
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-781-3133
Practice Address - Fax:270-846-0193
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60071545Medicaid