Provider Demographics
NPI:1912919705
Name:BUCHANAN, DONALD LAVERNE (DDS)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LAVERNE
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 1:2032 GREYSTONE PARK
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3575
Mailing Address - Country:US
Mailing Address - Phone:731-664-4999
Mailing Address - Fax:731-664-4944
Practice Address - Street 1:2032 GREYSTONE PARK
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3575
Practice Address - Country:US
Practice Address - Phone:731-664-4999
Practice Address - Fax:731-664-4944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0051611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice