MEDICARE: DR. JAMES M BUCHANAN JR. DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12780	MD
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	03584	NH
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	03584	NH

General Provider Information

NPI Number	:	1518993740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M BUCHANAN JR. DDS

Provider Business Mailing Address
First Line	:	126 STATE ST APT 7
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-3867
Country	:	US
Telephone Number	:	603-617-8818
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 OLDE WATERFORD WAY STE 1A
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-4168
Country	:	US
Telephone Number	:	910-371-3700
Fax Number	:	910-371-3720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	05/07/2013

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