MEDICARE: BUCHANAN DENTISTRY LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1912708918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCHANAN DENTISTRY LLC

Provider Business Mailing Address
First Line	:	6849 SIGRI ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-7015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5465 SIMMONS ST STE 4
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-9001
Country	:	US
Telephone Number	:	702-638-1005
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. CHARLES BUCHANAN
Credential	:	DMD
Telephone Number	:	702-716-6077

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	03/26/2025

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Directions to “BUCHANAN DENTISTRY LLC ” Practice Location

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