Healthcare Provider Details

I. General information

NPI: 1366818965
Provider Name (Legal Business Name): CHASE TALBOT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 2238, BOX #555221 1ST DENTAL BATTALION/ NAVAL DENTAL CENTER
CAMP PENDLETON CA
92055-5221
US

IV. Provider business mailing address

BUILDING 2238, BOX #555221 1ST DENTAL BATTALION
CAMP PENDLETON CA
92055-5221
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-5419
  • Fax:
Mailing address:
  • Phone: 760-725-5419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60576287
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: