MEDICARE: CHADWELL FAMILY DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	292200000X	Dental Laboratory	6417	NE

General Provider Information

NPI Number	:	1851759344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHADWELL FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	16909 LAKESIDE HILLS PLZ
Second Line	:	SUITE 111
City	:	OMAHA
State	:	NE
Zip	:	68130-4654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16909 LAKESIDE HILLS PLZ
Second Line	:	SUITE 111
City	:	OMAHA
State	:	NE
Zip	:	68130-4654
Country	:	US
Telephone Number	:	402-884-1828
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OWNER
Name	:	AMY CHADWELL
Credential	:
Telephone Number	:	402-884-1828

Provider Enumeration Date	:	01/29/2016
Last Update Date	:	01/29/2016

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