Provider Demographics
NPI:1063643435
Name:CHASE, AIYANA (DDS)
Entity Type:Individual
Prefix:
First Name:AIYANA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-334-3750
Mailing Address - Fax:210-922-0162
Practice Address - Street 1:9011 POTEET JOURDANTON FWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-2124
Practice Address - Country:US
Practice Address - Phone:210-921-6010
Practice Address - Fax:210-921-6188
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0024798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213998201Medicaid