Provider Demographics
NPI:1760254577
Name:DANIEL CHARTRAND DMD MS LLC
Entity Type:Organization
Organization Name:DANIEL CHARTRAND DMD MS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANGER
Authorized Official - Suffix:
Authorized Official - Credentials:FAADOM
Authorized Official - Phone:402-651-6430
Mailing Address - Street 1:10801 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3383
Mailing Address - Country:US
Mailing Address - Phone:402-330-1152
Mailing Address - Fax:402-330-3764
Practice Address - Street 1:10801 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3383
Practice Address - Country:US
Practice Address - Phone:402-330-1152
Practice Address - Fax:402-330-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty