Provider Demographics
NPI:1003853904
Name:FIFE, ERROL CHANDLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERROL
Middle Name:CHANDLER
Last Name:FIFE
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 1:1675 HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0982
Mailing Address - Country:US
Mailing Address - Phone:208-342-3695
Mailing Address - Fax:208-342-4065
Practice Address - Street 1:1675 HILL RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-0982
Practice Address - Country:US
Practice Address - Phone:208-342-3695
Practice Address - Fax:208-342-4065
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0025620000Medicaid