Provider Demographics
NPI:1922135714
Name:CHANDLER, BRYCE S (DDS)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:S
Last Name:CHANDLER
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 1:11021 OLD CORPUS CHRISTI HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223
Mailing Address - Country:US
Mailing Address - Phone:210-633-0057
Mailing Address - Fax:888-633-2279
Practice Address - Street 1:11021 OLD CORPUS CHRISTI HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223
Practice Address - Country:US
Practice Address - Phone:210-633-0057
Practice Address - Fax:888-633-2279
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009548101Medicaid