Provider Demographics
NPI:1245561133
Name:CHANDLER, MARY TERESA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:TERESA
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3074 ARVILLE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7490
Mailing Address - Country:US
Mailing Address - Phone:702-521-4550
Mailing Address - Fax:
Practice Address - Street 1:3074 ARVILLE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7490
Practice Address - Country:US
Practice Address - Phone:702-521-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-17
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3420124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1245561133Medicaid