Provider Demographics
NPI:1225235807
Name:CLAY CHANDLER DDS MD & BRIAN KELLEY DDS MD APC
Entity Type:Organization
Organization Name:CLAY CHANDLER DDS MD & BRIAN KELLEY DDS MD APC
Other - Org Name:LAFAYETTE ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-984-0403
Mailing Address - Street 1:3839 W CONGRESS ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6000
Mailing Address - Country:US
Mailing Address - Phone:337-984-0403
Mailing Address - Fax:337-981-9006
Practice Address - Street 1:3839 W CONGRESS ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6000
Practice Address - Country:US
Practice Address - Phone:337-984-0403
Practice Address - Fax:337-981-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU34680Medicare UPIN
LAT19758Medicare UPIN