Provider Demographics
NPI:1568604650
Name:CHANDLEY, DAMON WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:WAYNE
Last Name:CHANDLEY
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 1:4010 SEPULVEDA BLVD
Mailing Address - Street 2:#6 DAMON CHANDLEY, D.D.S.
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-406-3899
Mailing Address - Fax:310-406-3070
Practice Address - Street 1:4010 SEPULVEDA BLVD
Practice Address - Street 2:#6 DAMON CHANDLEY, D.D.S.
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-406-3899
Practice Address - Fax:310-406-3070
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38974122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice