Provider Demographics
NPI:1811009145
Name:BUCHANAN, JOHN PHILIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILIP
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 1:5800 RIDGEWOOD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2667
Mailing Address - Country:US
Mailing Address - Phone:601-956-9850
Mailing Address - Fax:601-956-9852
Practice Address - Street 1:5800 RIDGEWOOD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2667
Practice Address - Country:US
Practice Address - Phone:601-956-9850
Practice Address - Fax:601-956-9852
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2171854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist