Provider Demographics
NPI:1629185889
Name:CHVATAL, BRAD ALAN (DMD MS)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:ALAN
Last Name:CHVATAL
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1680 CHAMBERS ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402
Mailing Address - Country:US
Mailing Address - Phone:541-683-8490
Mailing Address - Fax:541-302-5750
Practice Address - Street 1:1680 CHAMBERS ST
Practice Address - Street 2:SUITE 205
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402
Practice Address - Country:US
Practice Address - Phone:541-683-8490
Practice Address - Fax:541-302-5750
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORD73661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics