Healthcare Provider Details

I. General information

NPI: 1932489234
Provider Name (Legal Business Name): JAMES A BUHANAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2443 MACKENZIE CREEK RD
CHULA VISTA CA
91914-3533
US

IV. Provider business mailing address

2005 KIGHT LANE MEDICAL STAFF SERVICES/ BLDG H
JACKSONVILLE FL
32212-0140
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8600
  • Fax:
Mailing address:
  • Phone: 619-532-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD008278
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: