Provider Demographics
NPI:1710972542
Name:CHADWELL, AMY TANEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:TANEL
Last Name:CHADWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16909 LAKESIDE HILLS PLZ
Mailing Address - Street 2:STE 111
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4654
Mailing Address - Country:US
Mailing Address - Phone:402-884-1828
Mailing Address - Fax:402-505-9791
Practice Address - Street 1:16909 LAKESIDE HILLS PLZ
Practice Address - Street 2:STE 111
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4654
Practice Address - Country:US
Practice Address - Phone:402-884-1828
Practice Address - Fax:402-505-9791
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100252469-00Medicaid
NE05273OtherBCBS PROVIDER ID