Provider Demographics
NPI:1558493924
Name:PACKER, CHIPMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHIPMAN
Middle Name:
Last Name:PACKER
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 1:2940 WEST 3650 SOUTH
Mailing Address - Street 2:SUTIE 202
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119
Mailing Address - Country:US
Mailing Address - Phone:801-417-5509
Mailing Address - Fax:801-417-8386
Practice Address - Street 1:2940 WEST 3650 SOUTH
Practice Address - Street 2:SUTIE 202
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119
Practice Address - Country:US
Practice Address - Phone:801-417-5509
Practice Address - Fax:801-417-8386
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62657349921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist