Provider Demographics
NPI:1871504555
Name:CHITSEY, DOUGLAS FRANKLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:FRANKLIN
Last Name:CHITSEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5554
Mailing Address - Country:US
Mailing Address - Phone:325-949-9696
Mailing Address - Fax:325-949-7989
Practice Address - Street 1:3419 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5554
Practice Address - Country:US
Practice Address - Phone:325-949-9696
Practice Address - Fax:325-949-7989
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD18076OtherBCBS
TX824601OtherUNITED CONCORDIA