Provider Demographics
NPI:1316033731
Name:CHASTAIN, JAMES TODD (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TODD
Last Name:CHASTAIN
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:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-0580
Mailing Address - Country:US
Mailing Address - Phone:256-757-4143
Mailing Address - Fax:256-757-4074
Practice Address - Street 1:150 J C MAULDIN HWY
Practice Address - Street 2:
Practice Address - City:KILLEN
Practice Address - State:AL
Practice Address - Zip Code:35645-9106
Practice Address - Country:US
Practice Address - Phone:256-757-4143
Practice Address - Fax:256-757-4074
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist