Provider Demographics
NPI:1225654106
Name:PACKARD, CHAD ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ROBERT
Last Name:PACKARD
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 1:320 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5409
Mailing Address - Country:US
Mailing Address - Phone:918-423-0091
Mailing Address - Fax:
Practice Address - Street 1:320 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5409
Practice Address - Country:US
Practice Address - Phone:918-423-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKT-7284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist