Provider Demographics
NPI:1114948601
Name:CHACE, JENNIFER BRENNAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BRENNAN
Last Name:CHACE
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 1:4479 N HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4800
Mailing Address - Country:US
Mailing Address - Phone:321-242-3300
Mailing Address - Fax:321-242-9393
Practice Address - Street 1:4479 N HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4800
Practice Address - Country:US
Practice Address - Phone:321-242-3300
Practice Address - Fax:321-242-9393
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice