Provider Demographics
NPI:1649344870
Name:BUCHANAN, GEORGE GLENN (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:GLENN
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 1:13720 229TH DR SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8468
Mailing Address - Country:US
Mailing Address - Phone:206-343-8929
Mailing Address - Fax:
Practice Address - Street 1:700 5TH AVE
Practice Address - Street 2:SUITE 1616
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-5058
Practice Address - Country:US
Practice Address - Phone:206-343-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA68071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice