Provider Demographics
NPI:1013064864
Name:CHANDLER, JEFFREY W (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 W BUTTERFIELD RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5068
Mailing Address - Country:US
Mailing Address - Phone:630-833-0395
Mailing Address - Fax:630-833-0399
Practice Address - Street 1:360 W BUTTERFIELD RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5068
Practice Address - Country:US
Practice Address - Phone:630-833-0395
Practice Address - Fax:630-833-0399
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036158773204E00000X
IL0190263141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV07050Medicare UPIN