Provider Demographics
NPI:1083622104
Name:KREIDER, CHANDRA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:L
Last Name:KREIDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 E EXPOSITION AVE STE 312
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-5032
Mailing Address - Country:US
Mailing Address - Phone:303-744-3636
Mailing Address - Fax:303-744-3724
Practice Address - Street 1:3955 E EXPOSITION AVE STE 312
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5032
Practice Address - Country:US
Practice Address - Phone:303-744-3636
Practice Address - Fax:303-744-3724
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice