Provider Demographics
NPI:1013062884
Name:CHADYS, JON DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:DAVID
Last Name:CHADYS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PURDY HILL RD
Mailing Address - Street 2:UNIT 3
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1661
Mailing Address - Country:US
Mailing Address - Phone:203-452-0239
Mailing Address - Fax:203-452-0713
Practice Address - Street 1:500 PURDY HILL RD
Practice Address - Street 2:UNIT 3
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1661
Practice Address - Country:US
Practice Address - Phone:203-452-0239
Practice Address - Fax:203-452-0713
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6283122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice