Provider Demographics
NPI:1225413750
Name:WOOTTON, CHASE M (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:M
Last Name:WOOTTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USA MEDDAC BAVARIA
Mailing Address - Street 2:UNIT 28038
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:0114963719-464-3965
Mailing Address - Fax:
Practice Address - Street 1:USA MEDDAC BAVARIA
Practice Address - Street 2:UNIT 28038
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:0114963719-464-3965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9403140-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice