Provider Demographics
NPI:1912942087
Name:CHIFFER, BRIAN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:CHIFFER
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 1:875 MAIN ST
Mailing Address - Street 2:P.O. BOX 356
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-2218
Mailing Address - Country:US
Mailing Address - Phone:860-633-6167
Mailing Address - Fax:860-657-2566
Practice Address - Street 1:875 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073-2218
Practice Address - Country:US
Practice Address - Phone:860-633-6167
Practice Address - Fax:860-657-2566
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice