Provider Demographics
NPI:1740485234
Name:BUCHANAN, TRENTON H (DMD)
Entity type:Individual
Prefix:
First Name:TRENTON
Middle Name:H
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 1:3132 VALLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5202
Mailing Address - Country:US
Mailing Address - Phone:720-277-5999
Mailing Address - Fax:
Practice Address - Street 1:140 VILLAGE ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5202
Practice Address - Country:US
Practice Address - Phone:720-277-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO94061223G0001X
AL55051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice