Provider Demographics
NPI:1730298738
Name:CHADWICK, JOANN LYNN (RDH)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:LYNN
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 TRAMORE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1922
Mailing Address - Country:US
Mailing Address - Phone:410-464-7578
Mailing Address - Fax:
Practice Address - Street 1:3715 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4208
Practice Address - Country:US
Practice Address - Phone:410-327-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5442124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist