Provider Demographics
NPI:1033230636
Name:ORDELHEIDE, CHAD T (DDS)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:T
Last Name:ORDELHEIDE
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 1:1602 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362
Mailing Address - Country:US
Mailing Address - Phone:509-525-2752
Mailing Address - Fax:509-525-9063
Practice Address - Street 1:1602 PENNY LN
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:509-525-2752
Practice Address - Fax:509-525-9063
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD10051223G0001X
CA527641223G0001X
WADE603169871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice