Provider Demographics
NPI:1659716058
Name:CHASOLEN, HOWARD M (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:M
Last Name:CHASOLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 WOOD ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-7900
Mailing Address - Country:US
Mailing Address - Phone:941-957-0063
Mailing Address - Fax:941-957-0424
Practice Address - Street 1:2033 WOOD ST
Practice Address - Street 2:SUITE 125
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7900
Practice Address - Country:US
Practice Address - Phone:941-957-0063
Practice Address - Fax:941-957-0424
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00137181223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics