Healthcare Provider Details

I. General information

NPI: 1285791210
Provider Name (Legal Business Name): WILLIAM BUCHANAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST UNIVERSITY DENTISTS SCHOOL OF DENTISTRY
JACKSON MS
39216-4500
US

IV. Provider business mailing address

186 E WATERWOOD DR
BRANDON MS
39047-6527
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6115
  • Fax:
Mailing address:
  • Phone: 601-984-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3210-01
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number17881
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number34735
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14236
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberPER-351-01
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: