Provider Demographics
NPI:1346300365
Name:HARRINGTON, CHAD FULTON (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:FULTON
Last Name:HARRINGTON
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 DOUGLAS RD.
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635
Mailing Address - Country:US
Mailing Address - Phone:574-233-7444
Mailing Address - Fax:574-233-7273
Practice Address - Street 1:3340 DOUGLAS RD.
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635
Practice Address - Country:US
Practice Address - Phone:574-233-7444
Practice Address - Fax:574-233-7273
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010498A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100312360-AMedicaid