Provider Demographics
NPI:1003102807
Name:NATHAN E. CHANDLER D.D.S. P.C.
Entity Type:Organization
Organization Name:NATHAN E. CHANDLER D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-571-3446
Mailing Address - Street 1:870 E 9400 S STE 101
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3693
Mailing Address - Country:US
Mailing Address - Phone:801-571-3446
Mailing Address - Fax:801-571-1340
Practice Address - Street 1:870 E 9400 S STE 101
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3693
Practice Address - Country:US
Practice Address - Phone:801-571-3446
Practice Address - Fax:801-571-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5386766261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental