Provider Demographics
NPI:1881854537
Name:CHANDLER, JEFFREY REUEL (DDS,MS,PC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:REUEL
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:DDS,MS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 FOOTHILL DR
Mailing Address - Street 2:SUITE #240
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2327
Mailing Address - Country:US
Mailing Address - Phone:801-581-1234
Mailing Address - Fax:801-581-1374
Practice Address - Street 1:1400 FOOTHILL DR
Practice Address - Street 2:SUITE #240
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-2327
Practice Address - Country:US
Practice Address - Phone:801-581-1234
Practice Address - Fax:801-581-1374
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6326958-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics