Provider Demographics
NPI:1487667986
Name:CHESSAR, JOHN RODERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RODERICK
Last Name:CHESSAR
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 1:15405 SW 116TH AVE
Mailing Address - Street 2:#208
Mailing Address - City:KING CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97224-4101
Mailing Address - Country:US
Mailing Address - Phone:503-684-0507
Mailing Address - Fax:503-684-0507
Practice Address - Street 1:15405 SW 116TH AVE
Practice Address - Street 2:#208
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-4101
Practice Address - Country:US
Practice Address - Phone:503-684-0507
Practice Address - Fax:503-684-0507
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROREGON 5771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist