Provider Demographics
NPI:1508880923
Name:CHAPMAN, KENNETH W (DMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:CHAPMAN
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 1:120 W HARPER ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-9424
Mailing Address - Country:US
Mailing Address - Phone:601-939-9502
Mailing Address - Fax:
Practice Address - Street 1:120 W HARPER ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-9424
Practice Address - Country:US
Practice Address - Phone:601-939-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1882-801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice