Provider Demographics
NPI:1467719401
Name:AITKEN, CHAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:AITKEN
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 1:5002 55 ST
Mailing Address - Street 2:#140
Mailing Address - City:RED DEER
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T4N7A4
Mailing Address - Country:CA
Mailing Address - Phone:403-343-7277
Mailing Address - Fax:
Practice Address - Street 1:5002 55 ST
Practice Address - Street 2:#140
Practice Address - City:RED DEER
Practice Address - State:ALBERTA
Practice Address - Zip Code:T4N7A4
Practice Address - Country:CA
Practice Address - Phone:403-343-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8005689-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist