Provider Demographics
NPI:1982840443
Name:CHASE, STEPHEN FOREST (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FOREST
Last Name:CHASE
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 1:227 MIDLAND AVE
Mailing Address - Street 2:SUITE C6
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8114
Mailing Address - Country:US
Mailing Address - Phone:970-927-1004
Mailing Address - Fax:970-927-4391
Practice Address - Street 1:227 MIDLAND AVE
Practice Address - Street 2:SUITE C6
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8114
Practice Address - Country:US
Practice Address - Phone:970-927-1004
Practice Address - Fax:970-927-4391
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics