Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 3668 | KY |
N | 1223D0001X | Dental Public Health | 3668 | KY |
NPI | 1093833923 |
---|---|
Provider Name | Mr. David Allen Buchanan |
First Address | Bowling Green, KY 42103 |
Second Address | Bowling Green, KY 42103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 23/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60036688 | (05) | KY |