Provider Demographics
NPI:1710393517
Name:DIEMER, CHASE CONWAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:CONWAY
Last Name:DIEMER
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 1:15208 BAUCH LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-5787
Mailing Address - Country:US
Mailing Address - Phone:501-831-1980
Mailing Address - Fax:
Practice Address - Street 1:15208 BAUCH LN
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-5787
Practice Address - Country:US
Practice Address - Phone:501-831-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist