Provider Demographics
NPI:1932300514
Name:CHAFFEE, MICHAEL P (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:CHAFFEE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W RIVERSTONE DR
Mailing Address - Street 2:STE. 301
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4967
Mailing Address - Country:US
Mailing Address - Phone:208-667-9212
Mailing Address - Fax:
Practice Address - Street 1:2140 W RIVERSTONE DR
Practice Address - Street 2:STE 301
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4967
Practice Address - Country:US
Practice Address - Phone:208-667-9212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD30771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics