Provider Demographics
NPI:1346478666
Name:DANSIE, CHASE O (DDS, DHSC)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:O
Last Name:DANSIE
Suffix:
Gender:M
Credentials:DDS, DHSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11996 S ANTHEM PARK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5643
Mailing Address - Country:US
Mailing Address - Phone:801-758-8888
Mailing Address - Fax:
Practice Address - Street 1:11996 S ANTHEM PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-5643
Practice Address - Country:US
Practice Address - Phone:801-758-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090145991223G0001X
UT69949891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice