Provider Demographics
NPI:1669566717
Name:BUCHANAN, BRIAN K (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
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 1:4178 SNAPFINGER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035
Mailing Address - Country:US
Mailing Address - Phone:404-289-7311
Mailing Address - Fax:404-289-7306
Practice Address - Street 1:1040 EAGLES LANDING PARKWAY BLDG 200
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:678-836-2136
Practice Address - Fax:770-961-4443
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist