Provider Demographics
NPI:1225127525
Name:CHASE, ANDREW S (DMD, MSD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:CHASE
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2982
Mailing Address - Country:US
Mailing Address - Phone:781-344-1150
Mailing Address - Fax:781-344-3668
Practice Address - Street 1:5 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2982
Practice Address - Country:US
Practice Address - Phone:781-344-1150
Practice Address - Fax:781-344-3668
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics