Provider Demographics
NPI:1053060087
Name:CHASTAIN, DAVID LUKE (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LUKE
Last Name:CHASTAIN
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 1:4217 SWISS AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6621
Mailing Address - Country:US
Mailing Address - Phone:325-998-0595
Mailing Address - Fax:
Practice Address - Street 1:4601 BUFFALO GAP RD STE C4
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3363
Practice Address - Country:US
Practice Address - Phone:325-692-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX378711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty