Healthcare Provider Details

I. General information

NPI: 1538484662
Provider Name (Legal Business Name): CHAD ALLEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 PAJARO ST
SALINAS CA
93901-2929
US

IV. Provider business mailing address

1124 PAJARO ST
SALINAS CA
93901-2929
US

V. Phone/Fax

Practice location:
  • Phone: 831-757-3021
  • Fax: 831-757-5833
Mailing address:
  • Phone: 831-757-3021
  • Fax: 831-757-5833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number59575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: