Provider Demographics
NPI:1619657186
Name:CHAD T EARDLEY DMD PLLC
Entity Type:Organization
Organization Name:CHAD T EARDLEY DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:EARDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-695-8522
Mailing Address - Street 1:645 S KNIGHTS WAY
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-6901
Mailing Address - Country:US
Mailing Address - Phone:602-695-8522
Mailing Address - Fax:
Practice Address - Street 1:550 W 2700 N
Practice Address - Street 2:UNIT 2
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84414
Practice Address - Country:US
Practice Address - Phone:602-695-8522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty