Provider Demographics
NPI:1639307184
Name:WASSINK, CHAD J (DDS)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:J
Last Name:WASSINK
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 1:2001 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-6063
Mailing Address - Country:US
Mailing Address - Phone:405-282-6440
Mailing Address - Fax:
Practice Address - Street 1:2001 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6063
Practice Address - Country:US
Practice Address - Phone:405-282-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK61231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice