MEDICARE: JOHN P. BUCHANAN, DMD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	217185	MS

General Provider Information

NPI Number	:	1336251669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN P. BUCHANAN, DMD, PA

Provider Business Mailing Address
First Line	:	5800 RIDGEWOOD RD
Second Line	:	SUITE 101
City	:	JACKSON
State	:	MS
Zip	:	39211-2667
Country	:	US
Telephone Number	:	601-956-9850
Fax Number	:	601-956-9852

Provider Business Practice Location Address
First Line	:	5800 RIDGEWOOD RD
Second Line	:	SUITE 101
City	:	JACKSON
State	:	MS
Zip	:	39211-2667
Country	:	US
Telephone Number	:	601-956-9850
Fax Number	:	601-956-9852

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN PHILIP BUCHANAN
Credential	:	D.M.D.
Telephone Number	:	601-956-9850

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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