Healthcare Provider Details

I. General information

NPI: 1487345492
Provider Name (Legal Business Name): KAYLA SHANNON BUCHANCZENKO RDH, DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30768 LYON CENTER DR E
NEW HUDSON MI
48165-8903
US

IV. Provider business mailing address

27418 POND DR
NEW HUDSON MI
48165-8536
US

V. Phone/Fax

Practice location:
  • Phone: 248-770-6042
  • Fax:
Mailing address:
  • Phone: 734-262-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2901028719
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603210
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: