Provider Demographics
NPI:1912297441
Name:CHADWICK, JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:K
Other - Last Name:CHADWICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2300 WAYNE MEMORIAL DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1726
Mailing Address - Country:US
Mailing Address - Phone:919-731-2620
Mailing Address - Fax:
Practice Address - Street 1:2300 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE H
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1726
Practice Address - Country:US
Practice Address - Phone:919-731-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WADR 60230156122300000X
NC94641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist