Provider Demographics
NPI:1053505107
Name:CHAPMAN, DICK ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:DICK
Middle Name:ALLEN
Last Name:CHAPMAN
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 1:3920 MARINERS WAY
Mailing Address - Street 2:324
Mailing Address - City:CORTEZ
Mailing Address - State:FL
Mailing Address - Zip Code:34215-2554
Mailing Address - Country:US
Mailing Address - Phone:727-946-1007
Mailing Address - Fax:
Practice Address - Street 1:3920 MARINERS WAY
Practice Address - Street 2:324
Practice Address - City:CORTEZ
Practice Address - State:FL
Practice Address - Zip Code:34215-2554
Practice Address - Country:US
Practice Address - Phone:727-946-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 93661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice