Provider Demographics
NPI:1467771386
Name:BUCHNER, ERIC RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RICHARD
Last Name:BUCHNER
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 1:22 HUNTINGTON PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9664
Mailing Address - Country:US
Mailing Address - Phone:502-693-7597
Mailing Address - Fax:
Practice Address - Street 1:190 MURRAY GUARD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3609
Practice Address - Country:US
Practice Address - Phone:731-668-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TNDS00000094391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program