Provider Demographics
NPI:1912766759
Name:CHATFIELD DENTAL CLINIC, L.L.C.
Entity Type:Organization
Organization Name:CHATFIELD DENTAL CLINIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-483-6364
Mailing Address - Street 1:1569 ECHO RIDGE RD SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-2873
Mailing Address - Country:US
Mailing Address - Phone:713-839-5404
Mailing Address - Fax:
Practice Address - Street 1:431 MAIN ST N STE B
Practice Address - Street 2:
Practice Address - City:CHATFIELD
Practice Address - State:MN
Practice Address - Zip Code:55923-1172
Practice Address - Country:US
Practice Address - Phone:832-483-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental