Provider Demographics
NPI:1811159023
Name:CHAPMAN, JASON KEITH (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:KEITH
Last Name:CHAPMAN
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 1:4A FLORENCE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-8559
Mailing Address - Country:US
Mailing Address - Phone:505-920-6086
Mailing Address - Fax:505-424-9775
Practice Address - Street 1:4A FLORENCE RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-8559
Practice Address - Country:US
Practice Address - Phone:505-920-6086
Practice Address - Fax:505-424-9775
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist