Provider Demographics
NPI:1497434823
Name:BOZARTH, CHANDLER (DDS)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:BOZARTH
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 1:118 BRIARWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-1851
Mailing Address - Country:US
Mailing Address - Phone:870-219-4969
Mailing Address - Fax:
Practice Address - Street 1:3555 HIGHWAY 412 E STE 10
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-7090
Practice Address - Country:US
Practice Address - Phone:479-373-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR46941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice