Provider Demographics
NPI:1760746986
Name:ANDREASON, CHASE LARUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:LARUE
Last Name:ANDREASON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 W RAY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3595
Mailing Address - Country:US
Mailing Address - Phone:480-814-9500
Mailing Address - Fax:480-814-9501
Practice Address - Street 1:2450 W RAY RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-814-9500
Practice Address - Fax:480-814-9501
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INLDR1200141223S0112X
AZD0096691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery