Provider Demographics
NPI:1669487211
Name:CHAPIN, EDWARD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:CHAPIN
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 1:1987 ROYAL AVE
Mailing Address - Street 2:#1
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4655
Mailing Address - Country:US
Mailing Address - Phone:805-526-7720
Mailing Address - Fax:805-526-7119
Practice Address - Street 1:1987 ROYAL AVE
Practice Address - Street 2:#1
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4655
Practice Address - Country:US
Practice Address - Phone:805-526-7720
Practice Address - Fax:805-526-7119
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist