Provider Demographics
NPI:1154469427
Name:CHELKOWSKI, JOHN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:CHELKOWSKI
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 1:4419 FRONTIER TRL
Mailing Address - Street 2:STE. 104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1686
Mailing Address - Country:US
Mailing Address - Phone:512-444-1133
Mailing Address - Fax:512-445-0552
Practice Address - Street 1:4419 FRONTIER TRL
Practice Address - Street 2:STE. 104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1686
Practice Address - Country:US
Practice Address - Phone:512-444-1133
Practice Address - Fax:512-445-0552
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice