Provider Demographics
NPI:1588634877
Name:CHAIRSELL, J. FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:FREDERICK
Last Name:CHAIRSELL
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 1:190 GOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2353
Mailing Address - Country:US
Mailing Address - Phone:717-394-3033
Mailing Address - Fax:717-390-2641
Practice Address - Street 1:190 GOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2353
Practice Address - Country:US
Practice Address - Phone:717-394-3033
Practice Address - Fax:717-390-2641
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018475L1223P0106X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA32271OtherBLUE SHIELD ID NUMBER
PA231944530OtherTAX ID
PA1730835Medicaid
PAT28628Medicare UPIN
PA231944530OtherTAX ID