Provider Demographics
NPI:1881116655
Name:GIDEL, CHAD (DMD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:GIDEL
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 1:3000 DAVISON CT
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-3271
Mailing Address - Country:US
Mailing Address - Phone:530-458-2101
Mailing Address - Fax:
Practice Address - Street 1:3000 DAVISON CT
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-3271
Practice Address - Country:US
Practice Address - Phone:530-458-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist