Healthcare Provider Details

I. General information

NPI: 1093833923
Provider Name (Legal Business Name): DAVID ALLEN BUCHANAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 PARK ST STE 100
BOWLING GREEN KY
42103
US

IV. Provider business mailing address

546 PARK ST STE 200
BOWLING GREEN KY
42103
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-3133
  • Fax: 270-846-0193
Mailing address:
  • Phone: 270-781-3133
  • Fax: 270-846-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number3668
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3668
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: