Provider Demographics
NPI:1487964821
Name:BUCHANAN, TERESA JUNE (RDHAP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:JUNE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:JUNE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TERESA CHILDS
Mailing Address - Street 1:22 BEAR GLEN DR
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-4433
Mailing Address - Country:US
Mailing Address - Phone:415-385-3398
Mailing Address - Fax:
Practice Address - Street 1:22 BEAR GLEN DR
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:CA
Practice Address - Zip Code:94062-4433
Practice Address - Country:US
Practice Address - Phone:415-385-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist