Provider Demographics
NPI:1578057147
Name:CHANDLER, KEEGAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEEGAN
Middle Name:
Last Name:CHANDLER
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 1:7608 W HIGHWAY 146 STE 200
Mailing Address - Street 2:
Mailing Address - City:PEWEE VALLEY
Mailing Address - State:KY
Mailing Address - Zip Code:40056-8102
Mailing Address - Country:US
Mailing Address - Phone:502-241-5055
Mailing Address - Fax:
Practice Address - Street 1:7608 W HIGHWAY 146 STE 200
Practice Address - Street 2:
Practice Address - City:PEWEE VALLEY
Practice Address - State:KY
Practice Address - Zip Code:40056-8102
Practice Address - Country:US
Practice Address - Phone:502-241-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice