MEDICARE: MR. DONALD LAVERNE BUCHANAN D.D.S

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	1223G0001X	General Practice Dentistry	DS005161	TN

General Provider Information

NPI Number	:	1912919705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD LAVERNE BUCHANAN D.D.S

Provider Business Mailing Address
First Line	:	2032 GREYSTONE PARK
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3575
Country	:	US
Telephone Number	:	731-664-4999
Fax Number	:	731-664-4944

Provider Business Practice Location Address
First Line	:	2032 GREYSTONE PARK
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3575
Country	:	US
Telephone Number	:	731-664-4999
Fax Number	:	731-664-4944

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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