Provider Demographics
NPI:1487345492
Name:BUCHANCZENKO, KAYLA SHANNON (RDH, DDS)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:SHANNON
Last Name:BUCHANCZENKO
Suffix:
Gender:F
Credentials:RDH, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27418 POND DR
Mailing Address - Street 2:
Mailing Address - City:NEW HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:48165-8536
Mailing Address - Country:US
Mailing Address - Phone:734-262-5599
Mailing Address - Fax:
Practice Address - Street 1:500 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501
Practice Address - Country:US
Practice Address - Phone:734-262-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2901028719124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist