Provider Demographics
NPI:1316352610
Name:BUCHANAN, AARON (DDS)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FAIRVIEW AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1920
Mailing Address - Country:US
Mailing Address - Phone:580-304-7590
Mailing Address - Fax:580-304-7591
Practice Address - Street 1:400 FAIRVIEW AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1920
Practice Address - Country:US
Practice Address - Phone:580-762-5335
Practice Address - Fax:580-304-7591
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK65821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice