Provider Demographics
NPI:1467922914
Name:BUCHANAN, TYLER ANDREW RICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ANDREW RICE
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 W DALLAS ST APT 1413
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4356
Mailing Address - Country:US
Mailing Address - Phone:425-941-0589
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 310
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3004
Practice Address - Country:US
Practice Address - Phone:425-941-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608825181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice