Provider Demographics
NPI:1629181789
Name:CHAPMAN, GARY EARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:EARL
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10121 SE SUNNYSIDE RD
Mailing Address - Street 2:SITE #330
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5745
Mailing Address - Country:US
Mailing Address - Phone:503-659-5000
Mailing Address - Fax:503-659-0168
Practice Address - Street 1:10121 SE SUNNYSIDE RD
Practice Address - Street 2:SITE #330
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5745
Practice Address - Country:US
Practice Address - Phone:503-659-5000
Practice Address - Fax:503-659-0168
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics