Provider Demographics
NPI:1417013806
Name:CHANDLER, JEFFREY KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KIM
Last Name:CHANDLER
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 1:10334 SHANNON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SHANNON HILLS
Mailing Address - State:AR
Mailing Address - Zip Code:72103-3363
Mailing Address - Country:US
Mailing Address - Phone:501-455-3176
Mailing Address - Fax:
Practice Address - Street 1:10334 SHANNON HILLS DR
Practice Address - Street 2:
Practice Address - City:SHANNON HILLS
Practice Address - State:AR
Practice Address - Zip Code:72103-3363
Practice Address - Country:US
Practice Address - Phone:501-455-3176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist