Provider Demographics
NPI:1720479892
Name:CHASE, ETHAN D (DMD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:D
Last Name:CHASE
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 1:142 PLEASANT VALLEY ST APT 40303
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7246
Mailing Address - Country:US
Mailing Address - Phone:860-899-9262
Mailing Address - Fax:
Practice Address - Street 1:375 6TH ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5935
Practice Address - Country:US
Practice Address - Phone:603-272-6094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH048931223G0001X
MA193481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice