Provider Demographics
NPI:1770149312
Name:CHISLER, CHRISTOPHER THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:CHISLER
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 1:6820 PARKDALE PL STE 117
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4699
Mailing Address - Country:US
Mailing Address - Phone:317-329-7373
Mailing Address - Fax:
Practice Address - Street 1:6820 PARKDALE PL STE 117
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4699
Practice Address - Country:US
Practice Address - Phone:317-329-7373
Practice Address - Fax:866-919-9416
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013149A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12013149AOtherIN PROFESSIONAL LICENSING ASSOCIATION