Provider Demographics
NPI:1457920811
Name:BUCHANON, CARL II (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:BUCHANON
Suffix:II
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 21ST ST APT 511
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2094
Mailing Address - Country:US
Mailing Address - Phone:574-514-1445
Mailing Address - Fax:
Practice Address - Street 1:707 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2210
Practice Address - Country:US
Practice Address - Phone:415-476-3276
Practice Address - Fax:415-514-2561
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000000000001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry