Provider Demographics
NPI:1912956467
Name:BUCHANAN, TESSA L (DDS)
Entity Type:Individual
Prefix:MISS
First Name:TESSA
Middle Name:L
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6382 GOLF LKS
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9366
Mailing Address - Country:US
Mailing Address - Phone:989-684-2286
Mailing Address - Fax:
Practice Address - Street 1:4915 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2905
Practice Address - Country:US
Practice Address - Phone:989-631-8913
Practice Address - Fax:989-631-0521
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID184571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice