Provider Demographics
NPI:1568565810
Name:JENNIFER S. CHADWELL DMD
Entity Type:Organization
Organization Name:JENNIFER S. CHADWELL DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:CHADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-256-5812
Mailing Address - Street 1:325 RICHMOND STREET
Mailing Address - Street 2:
Mailing Address - City:MT. VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456
Mailing Address - Country:US
Mailing Address - Phone:606-256-5812
Mailing Address - Fax:606-256-5812
Practice Address - Street 1:325 RICHMOND STREET
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456
Practice Address - Country:US
Practice Address - Phone:606-256-5812
Practice Address - Fax:606-256-5812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60070042Medicaid