Provider Demographics
NPI:1780817692
Name:CHARTIER ORTHODONTICS
Entity Type:Organization
Organization Name:CHARTIER ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:CHARTIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-891-1151
Mailing Address - Street 1:4320 RIDGECREST DR SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5971
Mailing Address - Country:US
Mailing Address - Phone:505-891-1151
Mailing Address - Fax:
Practice Address - Street 1:4320 RIDGECREST DR SE
Practice Address - Street 2:SUITE E
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5971
Practice Address - Country:US
Practice Address - Phone:505-891-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD29851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty