Provider Demographics
NPI:1336251867
Name:CHAPMAN, JEFFREY WADE (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WADE
Last Name:CHAPMAN
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 1:1910 S VIRGINIA ST
Mailing Address - Street 2:SUITE L04
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-3692
Mailing Address - Country:US
Mailing Address - Phone:270-885-7156
Mailing Address - Fax:
Practice Address - Street 1:1910 S VIRGINIA ST
Practice Address - Street 2:SUITE L04
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-3692
Practice Address - Country:US
Practice Address - Phone:270-885-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice