Provider Demographics
NPI:1205394319
Name:JAMES TODD CHASTAIN, DMD, LLC
Entity Type:Organization
Organization Name:JAMES TODD CHASTAIN, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-757-4143
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-0580
Mailing Address - Country:US
Mailing Address - Phone:256-757-4143
Mailing Address - Fax:256-757-4074
Practice Address - Street 1:150 J C MAULDIN HWY
Practice Address - Street 2:
Practice Address - City:KILLEN
Practice Address - State:AL
Practice Address - Zip Code:35645-9106
Practice Address - Country:US
Practice Address - Phone:256-757-4143
Practice Address - Fax:256-757-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental