Healthcare Provider Details

I. General information

NPI: 1386198679
Provider Name (Legal Business Name): GREGORY JAMES CHAFFIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 10/25/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 99 MISAWA AIR BASE MEDICAL GROUP
APO AP
96319
US

IV. Provider business mailing address

PSC 76 BOX 4026
APO AP
96319-0041
US

V. Phone/Fax

Practice location:
  • Phone: 315-226-6700
  • Fax:
Mailing address:
  • Phone: 315-226-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32095
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: