MEDICARE: DR. CHARLES V BUCHANAN DMD

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	122300000X	Dentist	7515	NV

General Provider Information

NPI Number	:	1407429889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES V BUCHANAN DMD

Provider Business Mailing 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	:

Provider Business Practice Location Address
First Line	:	5465 SIMMONS ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-9000
Country	:	US
Telephone Number	:	702-638-1005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	05/01/2025

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