Provider Demographics
NPI:1932343233
Name:CORNWELL, CHASITY DAWN
Entity Type:Individual
Prefix:MRS
First Name:CHASITY
Middle Name:DAWN
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHASITY
Other - Middle Name:DAWN
Other - Last Name:LANDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3924 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4945
Mailing Address - Country:US
Mailing Address - Phone:937-293-6387
Mailing Address - Fax:
Practice Address - Street 1:3924 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4945
Practice Address - Country:US
Practice Address - Phone:937-293-6387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant