Provider Demographics
NPI:1609306349
Name:FRUITHANDLER, CHAD EVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:EVAN
Last Name:FRUITHANDLER
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 1:1250 CHEROKEE ST APT 520
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3701
Mailing Address - Country:US
Mailing Address - Phone:915-731-6950
Mailing Address - Fax:
Practice Address - Street 1:1245 E COLFAX AVE STE 301
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-2216
Practice Address - Country:US
Practice Address - Phone:303-832-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00203185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist