Provider Demographics
NPI:1740309947
Name:CHAFIN, PHILLIP E (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:E
Last Name:CHAFIN
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 1:4502 S MCCOLL RD
Mailing Address - Street 2:CORNERSTONE MEDICAL PARK
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9739
Mailing Address - Country:US
Mailing Address - Phone:956-630-4900
Mailing Address - Fax:956-630-4900
Practice Address - Street 1:4502 S MCCOLL RD
Practice Address - Street 2:CORNERSTONE MEDICAL PARK
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9739
Practice Address - Country:US
Practice Address - Phone:956-630-4900
Practice Address - Fax:956-630-4900
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice