Provider Demographics
NPI:1922771161
Name:CONDER, CHASE (DMD)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:CONDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CHASE
Other - Middle Name:
Other - Last Name:KOETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:7844 STARLIGHT RD
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-8710
Mailing Address - Country:US
Mailing Address - Phone:502-836-2014
Mailing Address - Fax:
Practice Address - Street 1:5104 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9429
Practice Address - Country:US
Practice Address - Phone:812-941-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17501122300000X
IN12014027A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist