Provider Demographics
NPI:1013480565
Name:GOLTZ, CHANDLER ASHLEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:ASHLEE
Last Name:GOLTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CHANDLER
Other - Middle Name:ASHLEE
Other - Last Name:WEISBART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5300
Mailing Address - Country:US
Mailing Address - Phone:985-643-7516
Mailing Address - Fax:
Practice Address - Street 1:110 VILLAGE ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5300
Practice Address - Country:US
Practice Address - Phone:985-643-7516
Practice Address - Fax:985-646-2503
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0006587-C1122300000X
LA7164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist