Provider Demographics
NPI:1205925377
Name:CHILTON, J. CARL (DDS)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:CARL
Last Name:CHILTON
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 1:434 WEATHERLY ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4220
Mailing Address - Country:US
Mailing Address - Phone:806-274-5329
Mailing Address - Fax:806-274-7115
Practice Address - Street 1:434 WEATHERLY ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4220
Practice Address - Country:US
Practice Address - Phone:806-274-5329
Practice Address - Fax:806-274-7115
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice