Provider Demographics
NPI:1952529596
Name:CHACE DENTAL PL
Entity Type:Organization
Organization Name:CHACE DENTAL PL
Other - Org Name:GENTLE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHACE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-242-3300
Mailing Address - Street 1:4479 N HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4800
Mailing Address - Country:US
Mailing Address - Phone:321-242-3300
Mailing Address - Fax:321-242-9393
Practice Address - Street 1:4479 N HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4800
Practice Address - Country:US
Practice Address - Phone:321-242-3300
Practice Address - Fax:321-242-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty