Provider Demographics
NPI:1225263213
Name:CHADWICK, STEPHEN GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GREGORY
Last Name:CHADWICK
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 1:6222 NE 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8158
Mailing Address - Country:US
Mailing Address - Phone:206-543-5800
Mailing Address - Fax:206-543-0063
Practice Address - Street 1:6222 NE 74TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8158
Practice Address - Country:US
Practice Address - Phone:206-543-5800
Practice Address - Fax:206-543-0063
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR60464297122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70957FMedicaid